Healthcare Provider Details

I. General information

NPI: 1366071680
Provider Name (Legal Business Name): NIKOLAOS LONTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2433 COUNTRY PLACE BLVD BLDG B
TRINITY FL
34655-1163
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-8200
  • Fax:
Mailing address:
  • Phone: 727-828-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME160561
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: