Provider Demographics
NPI:1982934915
Name:KYRITSIS, ATHINA LYNN (MD)
Entity Type:Individual
Prefix:MS
First Name:ATHINA
Middle Name:LYNN
Last Name:KYRITSIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:25243 ELEMENTARY WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135
Mailing Address - Country:US
Mailing Address - Phone:239-498-9114
Mailing Address - Fax:239-498-6555
Practice Address - Street 1:25243 ELEMENTARY WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135
Practice Address - Country:US
Practice Address - Phone:239-498-9114
Practice Address - Fax:239-498-6555
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0066650208000000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
27366Medicare PIN
FLG10144Medicare UPIN