Provider Demographics
NPI:1316937485
Name:GONIS, DEMETRIOS (MD)
Entity type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:
Last Name:GONIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEMETRIOS
Other - Middle Name:
Other - Last Name:GONIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:INC
Mailing Address - Street 1:290 NICHOLAS PKWY NW
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-3804
Mailing Address - Country:US
Mailing Address - Phone:239-573-1152
Mailing Address - Fax:239-573-1360
Practice Address - Street 1:7025 N HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32927-5092
Practice Address - Country:US
Practice Address - Phone:321-305-6965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53510207R00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07411OtherBCBS
FL07411OtherBCBS
FL07411VMedicare ID - Type UnspecifiedINDIVIDUAL #
FLD51916Medicare UPIN
FLK4735Medicare ID - Type UnspecifiedGROUP #