Individual
ELIAS M. KOLETTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
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
207R00000X
Internal Medicine Physician
Primary
OS7623
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
255469100
—
FL
01
—
46556
BCBS
FL
Enumeration date
06/20/2005
Last updated
04/12/2016
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