Provider Demographics
NPI:1043521644
Name:ANTONOPOULOS, KOSTA P (DPM)
Entity Type:Individual
Prefix:DR
First Name:KOSTA
Middle Name:P
Last Name:ANTONOPOULOS
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:5885 SUNNYBROOK DR
Mailing Address - Street 2:STE E-100
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-4203
Mailing Address - Country:US
Mailing Address - Phone:712-266-2700
Mailing Address - Fax:712-266-2718
Practice Address - Street 1:5885 SUNNYBROOK DR
Practice Address - Street 2:STE E-100
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-4203
Practice Address - Country:US
Practice Address - Phone:712-266-2700
Practice Address - Fax:712-266-2718
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2015-07-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PASC006184213ES0103X
IA000869213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery