Provider Demographics
NPI:1568939478
Name:ISLAND FAMILY HEALTH LLC
Entity Type:Organization
Organization Name:ISLAND FAMILY HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIKOLAOS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANELLOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-208-8258
Mailing Address - Street 1:260 N TROPICAL TRL STE 105
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4800
Mailing Address - Country:US
Mailing Address - Phone:321-208-8258
Mailing Address - Fax:321-735-7186
Practice Address - Street 1:260 N TROPICAL TRL STE 105
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4800
Practice Address - Country:US
Practice Address - Phone:321-208-8258
Practice Address - Fax:321-735-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty