Organization
RENAISSANCE WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KONSTANTINE K YANKOPOLUS M.D. (PRESIDENT)
(239) 590-3883
Entity
Organization
Contact information
Practice address
3880 COLONIAL BLVD, SUITE 2, FORT MYERS, FL 33966-1062
(239) 590-3883
(239) 590-3884
Mailing address
3880 COLONIAL BLVD, SUITE 2, FORT MYERS, FL 33966-1062
(239) 590-3883
(239) 590-3884
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
ME22595
FL
Other
Enumeration date
03/05/2009
Last updated
07/31/2013
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