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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