Provider Demographics
NPI:1124014386
Name:NIKAS, DIMITRIOS (MD)
Entity Type:Individual
Prefix:
First Name:DIMITRIOS
Middle Name:
Last Name:NIKAS
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 1:323 W CONCORD PL
Mailing Address - Street 2:5
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5816
Mailing Address - Country:US
Mailing Address - Phone:312-573-0467
Mailing Address - Fax:
Practice Address - Street 1:323 W CONCORD PL
Practice Address - Street 2:5
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5816
Practice Address - Country:US
Practice Address - Phone:312-573-0467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113827207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-113827Medicaid