Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 20424 | AL |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 20424 | AL |
NPI | 1073661500 |
---|---|
Provider Name | Dimitris K Kyriazis |
First Address | Mobile, AL 36607-2303 |
Second Address | Mobile, AL 36607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 22/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000028805 | (05) | AL |
0118312 | (05) | MS |
1810002 | UHC (01) | AL |
4625754 | AETNA PROVIDER # AL (01) | AL |
51028805 | BCBS OF AL (01) | AL |
C592829 | HEALTHSPRINGS OF AL (01) | AL |
F59829 | (02) | AL |