Basic Information
Provider Information
NPI: 1245792696
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAMITIS
FirstName: ANTHONY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 515 WEKIVA COMMONS CIR
Address2:  
City: APOPKA
State: FL
PostalCode: 327123645
CountryCode: US
TelephoneNumber: 4074649516
FaxNumber: 4074649519
Practice Location
Address1: 515 WEKIVA COMMONS CIR
Address2:  
City: APOPKA
State: FL
PostalCode: 327123645
CountryCode: US
TelephoneNumber: 4074649516
FaxNumber: 4074649519
Other Information
ProviderEnumerationDate: 04/04/2019
LastUpdateDate: 06/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
207R00000XOS18859FLY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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