Healthcare Provider Details

I. General information

NPI: 1861660649
Provider Name (Legal Business Name): KONSTANTINE KONSTANTINE YANKOPOLUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3880 COLONIAL BLVD SUITE 2
FORT MYERS FL
33966-1062
US

IV. Provider business mailing address

3880 COLONIAL BLVD SUITE 2
FORT MYERS FL
33966-1062
US

V. Phone/Fax

Practice location:
  • Phone: 239-590-3883
  • Fax: 239-590-3884
Mailing address:
  • Phone: 239-590-3883
  • Fax: 239-590-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number022595
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME22595
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: