Provider Demographics
NPI:1851318646
Name:KORDONOWY, RAYMOND WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:WILLIAM
Last Name:KORDONOWY
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 1:6160 WINKLER RD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-8179
Mailing Address - Country:US
Mailing Address - Phone:239-362-3005
Mailing Address - Fax:239-239-3662
Practice Address - Street 1:6160 WINKLER RD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8179
Practice Address - Country:US
Practice Address - Phone:239-362-3005
Practice Address - Fax:239-239-3662
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0060336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18705VOtherUNSPECIFIED
F54801Medicare UPIN