Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 238578 | MA |
Y | 2084N0402X | Child Neurologist | 54890 | MN |
NPI | 1134365604 |
---|---|
Provider Name | Dimitrios Arkilo |
First Address | Saint Paul, MN 55102-2533 |
Second Address | Saint Paul, MN 55102-2533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2009 |
Last Update Date | 04/06/2013 |