Provider Demographics
NPI:1134295744
Name:FILUTOWSKI, KONRAD WLADYSLAW (MD,)
Entity Type:Individual
Prefix:
First Name:KONRAD
Middle Name:WLADYSLAW
Last Name:FILUTOWSKI
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 1:1070 GREENWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5404
Mailing Address - Country:US
Mailing Address - Phone:407-333-5111
Mailing Address - Fax:407-333-2434
Practice Address - Street 1:1070 GREENWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5404
Practice Address - Country:US
Practice Address - Phone:407-333-5111
Practice Address - Fax:407-333-2434
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50324207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4571717OtherGHI
FL062746100Medicaid
FL5257066OtherAETNA
FL03670OtherBCBSFL
FL5725132OtherCIGNA
FL03670XMedicare PIN
FL03670YMedicare PIN
FLD20833Medicare UPIN
FL4571717OtherGHI