Provider Demographics
NPI:1073661500
Name:KYRIAZIS, DIMITRIS K (MD)
Entity Type:Individual
Prefix:
First Name:DIMITRIS
Middle Name:K
Last Name:KYRIAZIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:866-401-3057
Mailing Address - Fax:318-868-6430
Practice Address - Street 1:1901 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607
Practice Address - Country:US
Practice Address - Phone:251-300-2240
Practice Address - Fax:251-300-2249
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20424174400000X, 2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000028805Medicaid
ALC592829OtherHEALTHSPRINGS OF AL
AL4625754OtherAETNA PROVIDER # AL
AL1810002OtherUHC
MS0118312Medicaid
AL51028805OtherBCBS OF AL
AL1810002OtherUHC
ALF59829Medicare UPIN
AL000028805Medicare PIN
ALC592829OtherHEALTHSPRINGS OF AL