Chaz Kisgeropoulos

Physician Assistant · Daytona Beach, FL

Individual Active NPI

NPI number 1235612581

Practice location

301 Memorial Medical Pkwy
Daytona Beach, FL 32117-5167
Phone
(386) 231-6000

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NPI record

NPI
1235612581
Entity type
Individual (Type 1)
Enumeration date
September 12, 2018
Last updated
January 14, 2020
Certified
January 14, 2020
Sole proprietor
Yes

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Physician Assistant Primary 363A00000X — —

Mailing address

5447 Carmody Lake Dr
Port Orange, FL 32128-7480
Phone
(386) 341-0652

Other practice locations (1)

  • 1690 Dunlawton Ave Ste 120, Port Orange, FL 32127-8980 · (386) 271-2273

About Chaz Kisgeropoulos

Chaz Kisgeropoulos is a healthcare provider registered in the NPI registry with the primary taxonomy Physician Assistant (code 363A00000X). The practice location is 301 Memorial Medical Pkwy, Daytona Beach, FL 32117-5167. The NPI number 1235612581 was assigned on September 12, 2018 and the record was last updated on January 14, 2020.

Frequently asked questions

What is the NPI number of Chaz Kisgeropoulos?

The NPI number is 1235612581.

What is the phone number of Chaz Kisgeropoulos?

The phone number listed for the practice location is (386) 231-6000.

Where is Chaz Kisgeropoulos located?

301 Memorial Medical Pkwy, Daytona Beach, FL 32117-5167.

What is the taxonomy code for Chaz Kisgeropoulos?

The primary taxonomy code is 363A00000X – Physician Assistant.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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