MEDICARE: DR. ALEXANDER KECHRIOTIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME70697	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46054	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1285628255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER KECHRIOTIS M.D.

Provider Business Mailing Address
First Line	:	1219 S EAST AVE
Second Line	:	SUITE 306
City	:	SARASOTA
State	:	FL
Zip	:	34239-2340
Country	:	US
Telephone Number	:	941-363-9100
Fax Number	:	941-363-9103

Provider Business Practice Location Address
First Line	:	1219 S EAST AVE
Second Line	:	SUITE 306
City	:	SARASOTA
State	:	FL
Zip	:	34239-2340
Country	:	US
Telephone Number	:	941-363-9100
Fax Number	:	941-363-9103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	07/08/2007

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