Provider Demographics
NPI:1679556757
Name:KOPIDAKIS, GEORGE E (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:KOPIDAKIS
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 1:1530 LEE BLVD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-4893
Mailing Address - Country:US
Mailing Address - Phone:239-368-0241
Mailing Address - Fax:
Practice Address - Street 1:1530 LEE BLVD
Practice Address - Street 2:SUITE 1100
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4893
Practice Address - Country:US
Practice Address - Phone:239-368-0241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74612208600000X
NJMA05921000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP951167OtherOPTIMUM
FL009552700Medicaid
FL367678OtherAVMED
FLP01214443OtherRAILROAD MCR
FLP1011919OtherFREEDOM HEALTH
FL802555OtherWELLCARE
FL0900046OtherCIGNA
FL14R8XOtherBCBS OF FL
FLHM048ZMedicare PIN
FL802555OtherWELLCARE
FL009552700Medicaid