MEDICARE: ISLAND FAMILY HEALTH 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1568939478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND FAMILY HEALTH LLC

Provider Business Mailing Address
First Line	:	260 N TROPICAL TRL STE 105
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4800
Country	:	US
Telephone Number	:	321-208-8258
Fax Number	:	321-735-7186

Provider Business Practice Location Address
First Line	:	260 N TROPICAL TRL STE 105
Second Line	:
City	:	MERRITT ISLAND
State	:	FL
Zip	:	32953-4800
Country	:	US
Telephone Number	:	321-208-8258
Fax Number	:	321-735-7186

Authorized Official
Title or Position	:	OWNER
Name	:	NIKOLAOS KANELLOPOULOS
Credential	:	MD
Telephone Number	:	321-208-8258

Provider Enumeration Date	:	10/29/2018
Last Update Date	:	08/26/2022

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Directions to “ISLAND FAMILY HEALTH LLC ” Practice Location

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