Provider Demographics
NPI:1952382020
Name:COUNDOURIOTIS, ANDREW (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:COUNDOURIOTIS
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 1:5600 22ND ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2126
Mailing Address - Country:US
Mailing Address - Phone:727-525-9900
Mailing Address - Fax:727-525-9200
Practice Address - Street 1:5600 22ND ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2126
Practice Address - Country:US
Practice Address - Phone:727-525-9900
Practice Address - Fax:727-525-9200
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061858207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370923000Medicaid
FL17731XMedicare ID - Type Unspecified
FL370923000Medicaid