=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326071499
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZANNOS GIORGIOS GREKOS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9500 BONITA BEACH RD SE SUITE 310 REGENCE MEDICAL CENTER
-----------------------------------------------------
City | BONITA SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34135-4698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-498-9114
-----------------------------------------------------
Fax | 239-498-6555
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9500 BONITA BEACH RD SE SUITE 310 REGENCE MEDICAL CENTER
-----------------------------------------------------
City | BONITA SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34135-4698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-498-9114
-----------------------------------------------------
Fax | 239-498-6555
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME 0061912
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------