MEDICARE: DR. NIKOLAOS KANELLOPOULOS MD

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	ME113375	FL

General Provider Information

NPI Number	:	1760611867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKOLAOS KANELLOPOULOS MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	08/26/2022

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