Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301082055 | MI |
N | 207X00000X | Orthopaedic Surgeon | 57.012616 | OH |
N | 207XS0117X | Orthopaedic Spine Surgeon | NP082055 | MI |
NPI | 1407045602 |
---|---|
Provider Name | Dr. Nicholas S. Papakonstantinou |
First Address | Rochester Hills, MI 48307-5624 |
Second Address | Rochester Hills, MI 48307-5624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 03/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1407045602 | (02) | MI |
200922840 | (05) | MI |