Provider Demographics
NPI:1669767109
Name:REKKAS, STELIOS (MD)
Entity type:Individual
Prefix:DR
First Name:STELIOS
Middle Name:
Last Name:REKKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:STELIO
Other - Middle Name:
Other - Last Name:REKKAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATT IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:775-356-9393
Mailing Address - Fax:775-356-5590
Practice Address - Street 1:232 MANATEE AVENUE EAST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1932
Practice Address - Country:US
Practice Address - Phone:941-254-4957
Practice Address - Fax:941-254-4958
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL110761208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006798500Medicaid
FL14M8ROtherBCBS
FL006798500Medicaid