Provider Demographics
NPI:1417016569
Name:KOKOLIS, RODAMANTHOS NICHOLAS (MD)
Entity type:Individual
Prefix:
First Name:RODAMANTHOS
Middle Name:NICHOLAS
Last Name:KOKOLIS
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 1:1 N PINELLAS AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3415
Mailing Address - Country:US
Mailing Address - Phone:727-939-3090
Mailing Address - Fax:727-939-3091
Practice Address - Street 1:1 N PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3415
Practice Address - Country:US
Practice Address - Phone:727-939-3090
Practice Address - Fax:727-939-3091
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234183207RC0000X, 207R00000X
FLME114286207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine