Doctor Name: | DR. DIMITRIOS PANAGOPOULOS |
NPI Number: | 1528032786 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DPM |
License Number: | 5901002021 |
Business Practice Address: | 24025 Greater Mack Ave Suite 101 St Clair Shores, MI - 480801486 |
Business Phone Number: | 3138847566 |
Business Fax Number: | 3138843140 |
Mailing Address: | 24025 Greater Mack Ave, Suite 101 ST CLAIR SHORES |
State: | MI |
Postal Code: | 480801486 |
Phone Number: | 3138847566 |
Fax Number: | 3138843140 |
NPI Enumeration Date: | 02/15/2006 |
NPI Last Update Date: | 01/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | 5901002021 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |