Individual
CHAZ KISGEROPOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 MEMORIAL MEDICAL PKWY, DAYTONA BEACH, FL 32117-5167
(386) 231-6000
Mailing address
5447 CARMODY LAKE DR, PORT ORANGE, FL 32128-7480
(386) 341-0652
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/12/2018
Last updated
01/14/2020
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