Healthcare Provider Details

I. General information

NPI: 1669767109
Provider Name (Legal Business Name): STELIOS REKKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STELIO REKKAS MD

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MANATEE AVENUE EAST
BRADENTON FL
34208-1932
US

IV. Provider business mailing address

367 S. GULPH RD ATT IPM CREDENTIALING
KING OF PRUSSIA PA
19406-3121
US

V. Phone/Fax

Practice location:
  • Phone: 941-254-4957
  • Fax: 941-254-4958
Mailing address:
  • Phone: 775-356-9393
  • Fax: 775-356-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number110761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: