Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 12926 | ND |
N | 2080P0208X | Pediatric Infectious Diseases | 12926 | ND |
NPI | 1356692339 |
---|---|
Provider Name | Mr. Miltiadis Douvoyiannis |
First Address | Grand Forks, ND 58201 |
Second Address | Grand Forks, ND 58201-4059 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2012 |
Last Update Date | 18/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
N719062 | (02) | ND |