Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 01072513A | IN |
N | 208800000X | Urologist | 051471 | CT |
NPI | 1003066580 |
---|---|
Provider Name | Hristos Kaimakliotis |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-5306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2008 |
Last Update Date | 23/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201189840 | (05) | IN |