Individual
CHRISTO W KOULISIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1003 COLLEGE BLVD W, SUITE 4, NICEVILLE, FL 32578-1060
(850) 279-6789
(850) 279-6546
Mailing address
1003 COLLEGE BLVD W STE 4, NICEVILLE, FL 32578-1060
(850) 279-6789
(850) 279-6546
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME0053933
FL
207X00000X
Orthopaedic Surgery Physician
4301503101
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07915
BLUE CROSS BLUE SHIELD
FL
01
—
162510700
DEPARTMENT OF LABOR
FL
05
—
256355000
—
FL
Enumeration date
10/20/2005
Last updated
12/29/2022
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