MEDICARE: DR. DEMETRAJANE KOKINAKIS DO

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	207W00000X	Ophthalmology Physician	1068	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770579013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEMETRAJANE KOKINAKIS DO

Provider Business Mailing Address
First Line	:	1664 RIBAUT RD
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1708
Country	:	US
Telephone Number	:	843-522-8466
Fax Number	:	843-521-4538

Provider Business Practice Location Address
First Line	:	1664 RIBAUT RD
Second Line	:
City	:	PORT ROYAL
State	:	SC
Zip	:	29935-1708
Country	:	US
Telephone Number	:	843-522-8466
Fax Number	:	843-521-4538

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

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	10/27/2020

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