MEDICARE: KOLETTIS KREW LLC

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	174400000X	Specialist	OS0007623	FL
2	207R00000X	Internal Medicine Physician		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	46556	OTHER	FL	BCBS
2	2161129	OTHER	FL	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457533762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KOLETTIS KREW LLC

Provider Business Mailing Address
First Line	:	701 N. HERCULES AVE
Second Line	:	STE. B
City	:	CLEARWATER
State	:	FL
Zip	:	33765-2029
Country	:	US
Telephone Number	:	727-738-8410
Fax Number	:	727-734-6254

Provider Business Practice Location Address
First Line	:	701 N. HERCULES AVE
Second Line	:	STE B
City	:	CLEARWATER
State	:	FL
Zip	:	33765-2029
Country	:	US
Telephone Number	:	727-738-8410
Fax Number	:	727-734-6254

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ELIAS M KOLETTIS
Credential	:	D.O.
Telephone Number	:	727-738-8410

Provider Enumeration Date	:	11/28/2007
Last Update Date	:	03/24/2016

Similar Medicare Providers

1346245891 — ELIAS M. KOLETTIS D.O.
Practice Location Address:

701 N HERCULES AVE , STE B
CLEARWATER, FL
33765-2029

Practice Phone: 727-738-8410
Practice Fax: 727-734-6254

1306041421 — CLEARWATER ORTHOPEDIC & SPORTS MEDICINE INC
Practice Location Address:

701 N HERCULES AVE STE A
CLEARWATER, FL
33765-2029

Practice Phone: 727-562-9317
Practice Fax:

1356763098 — RACHEL REY DC
Practice Location Address:

701 N HERCULES AVE STE E
CLEARWATER, FL
33765-2029

Practice Phone: 727-867-5292
Practice Fax: 727-286-8538

1386635548 — JENNIFER L. BALL DO
Practice Location Address:

3280 N MCMULLEN BOOTH RD , SUITE 200
CLEARWATER, FL
33761-2029

Practice Phone: 727-216-1141
Practice Fax: 727-796-6459

1639149313 — MICHAEL J TOLENTINO MD
Practice Location Address:

3280 N MCMULLEN BOOTH RD , SUITE 120
CLEARWATER, FL
33761-2029

Practice Phone: 727-789-8770
Practice Fax: 727-789-8784

1700190352 — SAFETY HARBOR SURGERY CENTER, LLC
Practice Location Address:

3280 N MCMULLEN BOOTH RD , SUITE 110
CLEARWATER, FL
33761-2029

Practice Phone: 727-789-8770
Practice Fax: 727-789-8784

Directions to “KOLETTIS KREW LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.