Provider Demographics
NPI:1023178464
Name:MARKOPOULOS, MICHAEL NICOLAS (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NICOLAS
Last Name:MARKOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2683 VIA DE LA VALLE
Mailing Address - Street 2:G626
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1911
Mailing Address - Country:US
Mailing Address - Phone:858-481-0412
Mailing Address - Fax:858-481-6066
Practice Address - Street 1:2683 VIA DE LA VALLE
Practice Address - Street 2:G626
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-1911
Practice Address - Country:US
Practice Address - Phone:858-481-0412
Practice Address - Fax:858-481-6066
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG346870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G346870Medicaid
CAG346870OtherLICENSE
CAW7278Medicare ID - Type UnspecifiedGROUP NUMBER
CAG346870OtherLICENSE