Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | ME150711 | FL |
N | 208600000X | Surgeon | ME150711 | FL |
Y | 2086X0206X | Surgical Oncologist | ME150711 | FL |
NPI | 1215349022 |
---|---|
Provider Name | Konstantinos Chouliaras |
First Address | Jacksonville, FL 32232-5274 |
Second Address | Jacksonville, FL 32207-8432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 07/10/2021 |