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General NPI Number Information
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NPI Number | 1568939478
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Entity Type | Organization
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Legal Business Name | ISLAND FAMILY HEALTH LLC
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Dates
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Enumeration Date | 10/29/2018
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 260 N TROPICAL TRL STE 105
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4800
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Country | US
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Telephone | 321-208-8258
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Fax | 321-735-7186
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Provider Business Mailing Address
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Address Line | 260 N TROPICAL TRL STE 105
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City | MERRITT ISLAND
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State | FL
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Zip | 32953-4800
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Country | US
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Telephone | 321-208-8258
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Fax | 321-735-7186
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Authorized Official
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Title or Position | OWNER
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Name | NIKOLAOS KANELLOPOULOS
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Credential | MD
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Telephone | 321-208-8258
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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 |
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License Number State |
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