Healthcare Provider Details

I. General information

NPI: 1053608505
Provider Name (Legal Business Name): KONSTANTINOS MARMAGKIOLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 W DR MARTIN LUTHER KING JR BLVD STE 800
TAMPA FL
33607-6065
US

IV. Provider business mailing address

2727 W DR MARTIN LUTHER KING JR BLVD STE 800
TAMPA FL
33607-6065
US

V. Phone/Fax

Practice location:
  • Phone: 813-873-0000
  • Fax: 813-873-3659
Mailing address:
  • Phone: 813-873-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME127598
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME127598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: