Provider Demographics
NPI:1194758078
Name:KITSOS, CONSTANTINE NICHOLAS (MD)
Entity type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:NICHOLAS
Last Name:KITSOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138
Mailing Address - Country:US
Mailing Address - Phone:305-754-0400
Mailing Address - Fax:305-754-0045
Practice Address - Street 1:9000 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138
Practice Address - Country:US
Practice Address - Phone:305-754-0400
Practice Address - Fax:305-754-0045
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL117292086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D59828Medicare UPIN
FL91822Medicare ID - Type Unspecified