NPIMap

Organization Active NPI

Angelos Koutsonikolis MD PA

  • Allergy & Immunology Physician
  • Boynton Beach, FL
National Provider Identifier
1366639262
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy & Immunology PhysicianTaxonomy code 207K00000X
License
ME63824 Issued in FL
Legal business name
ANGELOS KOUTSONIKOLIS MD PA
Practice address
10075 Jog Rd
Suite 100
Boynton Beach, FL 33437-3535
Phone
(561) 733-3546
Fax
(561) 733-3547
NPI assigned
Sep 25, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Angelos Koutsonikolis, MEDICAL DOCTORNPI 1295847978
Title
President
Phone
(561) 733-3546

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy & Immunology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207K00000X ME63824 FL Primary

Addresses

Primary practice location

10075 Jog Rd
Suite 100
Boynton Beach, FL 33437-3535

Mailing address

10075 Jog Rd
Suite 100
Boynton Beach, FL 33437-3535
Phone (561) 733-3546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050523000363 FL Part B Supplier - Clinic/Group Practice 6901847797 Receives reassigned benefits from 1 practitioner
Practice locations: Boynton Beach, FL

National Provider Directory

National Provider Directory

Locations

10075 S Jog Rd
Ste 100
Boynton Beach, FL 33437
Phone (561) 733-3546

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1366639262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10075 JOG RD",
            "address_2": "SUITE 100",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334373535",
            "telephone_number": "561-733-3546",
            "fax_number": "561-733-3547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10075 JOG RD",
            "address_2": "SUITE 100",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334373535",
            "telephone_number": "561-733-3546",
            "fax_number": "561-733-3547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELOS KOUTSONIKOLIS MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "KOUTSONIKOLIS",
        "authorized_official_first_name": "ANGELOS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "561-733-3546",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MEDICAL DOCTOR"
    },
    "taxonomies": [
        {
            "code": "207K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Allergy & Immunology",
            "state": "FL",
            "license": "ME63824",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boynton Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.