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Organization
FAMILY HEALTH CENTER OF SOUTHERN MAINE, P.A.
Active
Organization
FAMILY HEALTH CENTER OF SOUTHERN MAINE, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN EDWARD KAZILIONIS D.O. (PRESIDENT)
(207) 775-7758
Entity
Organization
Contact information
Practice address
778 MAIN ST, SUITE #1, SOUTH PORTLAND, ME 04106-5447
(207) 775-7758
(207) 879-7758
Mailing address
778 MAIN ST, SUITE #1, SOUTH PORTLAND, ME 04106-5447
(207) 775-7758
(207) 879-7758
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
917
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041126
BLUE CROSS
ME
01
—
2541034
AETNA
ME
01
—
M197320
CIGNA
ME
Enumeration date
02/06/2007
Last updated
08/22/2020
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