Healthcare Provider Details

I. General information

NPI: 1497046957
Provider Name (Legal Business Name): DEMETRIOS GONIS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2011
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 NICHOLAS PKWY NW SUITE 1
CAPE CORAL FL
33991-3804
US

IV. Provider business mailing address

290 NICHOLAS PKWY NW SUITE 1
CAPE CORAL FL
33991-3804
US

V. Phone/Fax

Practice location:
  • Phone: 239-573-1152
  • Fax: 239-573-1360
Mailing address:
  • Phone: 239-573-1152
  • Fax: 239-573-1360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME53510
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberME53510
License Number StateFL

VIII. Authorized Official

Name: DR. DEMETRIOS GONIS
Title or Position: OWNER/ MD
Credential: MD
Phone: 239-573-1152