Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 000869 | IA |
N | 213ES0103X | Foot & Ankle Surgery | SC006184 | PA |
NPI | 1043521644 |
---|---|
Provider Name | Dr. Kosta P Antonopoulos |
First Address | Sioux City, IA 51106-4203 |
Second Address | Sioux City, IA 51106-4203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2010 |
Last Update Date | 27/07/2015 |