Provider Demographics
NPI:1497046957
Name:DEMETRIOS GONIS INC.
Entity Type:Organization
Organization Name:DEMETRIOS GONIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-573-1152
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 1:290 NICHOLAS PKWY NW
Practice Address - Street 2:SUITE 1
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-3804
Practice Address - Country:US
Practice Address - Phone:239-573-1152
Practice Address - Fax:239-573-1360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53510207R00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty