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General NPI Number Information
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NPI Number | 1477692010
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Entity Type | Organization
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Legal Business Name | FAMILY HEALTH CENTER OF SOUTHERN MAINE, P.A.
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 778 MAIN ST SUITE #1
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5447
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Country | US
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Telephone | 207-775-7758
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Fax | 207-879-7758
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Provider Business Mailing Address
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Address Line | 778 MAIN ST SUITE #1
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-5447
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Country | US
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Telephone | 207-775-7758
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Fax | 207-879-7758
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN EDWARD KAZILIONIS
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Credential | D.O.
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Telephone | 207-775-7758
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 917
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License Number State | ME
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