Organization
INNOVATIVE DERMATOLOGY AND MOHS SURGERY LLC
Active
Organization
INNOVATIVE DERMATOLOGY AND MOHS SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW P KONTOS M.D. (OWNER)
(239) 368-8071
Entity
Organization
Contact information
Practice address
3507 LEE BLVD, STE 107, LEHIGH ACRES, FL 33971-1318
(239) 368-8071
(239) 368-8074
Mailing address
3507 LEE BLVD, STE 107, LEHIGH ACRES, FL 33971-1318
(239) 368-8071
(239) 368-8074
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME96589
FL
Other
Enumeration date
04/03/2015
Last updated
04/03/2015
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