Dzamashvili, Konstantin
Dzamashvili, Konstantin is an individual health care provider with primary practice located at 12670 Whitehall Dr , Fort Myers FL 33907-3619. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Vascular Neurology. Allopathic & Osteopathic Physicians / Neurology is his primary health care specialty. Dzamashvili, Konstantin can be contacted via phone (239) 936-3554.Contact Information
Primary practice address
12670 Whitehall Dr
Fort Myers FL 33907-3619
Phone: (239) 936-3554
Fax: (239) 936-8993
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 036093821 | Illinois |
| Allopathic & Osteopathic Physicians / Vascular Neurology | 2084V0102X | 036093821 | Illinois |
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | ME126918 | Florida |
Profile Details
| NPI number | 1174529085 |
|---|---|
| LBN Legal business name | Dzamashvili, Konstantin |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 24th, 2005 |
| Last updated | Nov 18th, 2016 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1174529085 | NPPES |
| Other | 206147046 | MEDICARE PTAN (INDIVIDUAL) | |
| Other | CA4748 | MEDICARE PTAN (INDIVIDUAL) | |
| Other | 206147 | MEDICARE PTAN (INDIVIDUAL) | |
| Other | 036093821 | MEDICARE PTAN (INDIVIDUAL) | |
| MEDICAID | 036093821 | MEDICARE PTAN (INDIVIDUAL) | |
| Other | P00904562 | MEDICARE PTAN (INDIVIDUAL) |
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