Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 77854 | MA |
Y | 207RX0202X | Medical Oncology | 49332 | AZ |
N | 207RX0202X | Medical Oncology | 77854 | MA |
NPI | 1396735585 |
---|---|
Provider Name | Dr. Panagiotis Mihalis Fidias |
First Address | Phoenix, AZ 85004-2155 |
Second Address | Phoenix, AZ 85004-2155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 30/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
077854 | TUFTS HEALTH PLAN (01) | MA |
3188001 | (05) | MA |
G33618 | (02) | |
J19643 | BCBS MA (01) | MA |