Provider Demographics
NPI:1114941937
Name:KAZILIONIS, JOHN EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:KAZILIONIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5447
Mailing Address - Country:US
Mailing Address - Phone:207-775-7758
Mailing Address - Fax:207-879-7758
Practice Address - Street 1:778 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5447
Practice Address - Country:US
Practice Address - Phone:207-775-7758
Practice Address - Fax:207-879-7758
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME203900099Medicaid
ME203900099Medicaid
ME203900099Medicaid
D94297Medicare UPIN
CK6505Medicare PIN
ME01-0544015OtherTIN