Provider Demographics
NPI:1174913529
Name:ATHAN P KARTSONIS MD
Entity type:Organization
Organization Name:ATHAN P KARTSONIS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KARTSONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-984-1981
Mailing Address - Street 1:1301 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3223
Mailing Address - Country:US
Mailing Address - Phone:321-984-1981
Mailing Address - Fax:321-728-8554
Practice Address - Street 1:1301 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3223
Practice Address - Country:US
Practice Address - Phone:321-984-1981
Practice Address - Fax:321-728-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42738207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02786Medicare UPIN