Provider Demographics
NPI:1790764272
Name:AGALIOTIS, DIMITRIOS PHILIPPES (MD)
Entity Type:Individual
Prefix:
First Name:DIMITRIOS
Middle Name:PHILIPPES
Last Name:AGALIOTIS
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 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: MANAGED CARE DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1699 S 14TH ST STE 2
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034
Practice Address - Country:US
Practice Address - Phone:904-427-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0065592207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000786497EMedicaid
FL253978100Medicaid
GA000786497IMedicaid
FL43641OtherBCBS
FL245885OtherAVMED
FLP01593272OtherRR MEDICARE
FL1100413OtherCAREPLUS
FL1245927OtherSTAYWELL (MEDICAID) AND WELLCARE (MEDICARE)
FLP0022927OtherFLORIDA HEALTHCARE PLUS
FLP10703334OtherSIMPLY HEALTHCARE
GA000786497IMedicaid
FLP0022927OtherFLORIDA HEALTHCARE PLUS
FL1245927OtherSTAYWELL (MEDICAID) AND WELLCARE (MEDICARE)
GA000786497EMedicaid
FL43641UMedicare PIN