Healthcare Provider Details

I. General information

NPI: 1891721627
Provider Name (Legal Business Name): CHRIS KECHRIOTIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WATERMAN WAY
TAVARES FL
32778-5266
US

IV. Provider business mailing address

2755 S BAY ST SUITE C
EUSTIS FL
32726-6587
US

V. Phone/Fax

Practice location:
  • Phone: 352-253-3374
  • Fax: 352-589-4140
Mailing address:
  • Phone: 352-343-3434
  • Fax: 352-589-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME0055309
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: