Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 04-25099 | KS |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 106257 | MO |
NPI | 1023075272 |
---|---|
Provider Name | Dr. Constantine Lan Fotopoulos |
First Address | Leawood, KS 66211 |
Second Address | Kansas City, MO 64111-5941 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 09/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F95898 | (02) |