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Organization
KOLETTIS KREW LLC
Active
Organization
KOLETTIS KREW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIAS M KOLETTIS D.O. (PHYSICIAN)
(727) 738-8410
Entity
Organization
Contact information
Practice address
701 N. HERCULES AVE, STE B, CLEARWATER, FL 33765-2029
(727) 738-8410
(727) 734-6254
Mailing address
701 N. HERCULES AVE, STE. B, CLEARWATER, FL 33765-2029
(727) 738-8410
(727) 734-6254
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OS0007623
FL
207R00000X
Internal Medicine Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2161129
AETNA
FL
05
—
255469100
—
FL
01
—
46556
BCBS
FL
Enumeration date
11/28/2007
Last updated
03/24/2016
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