Provider Demographics
NPI:1154322741
Name:ELLINAS, PANAYIOTIS A II (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PANAYIOTIS
Middle Name:A
Last Name:ELLINAS
Suffix:II
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 COLE AVE
Mailing Address - Street 2:CQCH BILLING DEPT
Mailing Address - City:BISBEE
Mailing Address - State:AZ
Mailing Address - Zip Code:85603-1327
Mailing Address - Country:US
Mailing Address - Phone:520-432-6452
Mailing Address - Fax:520-432-8018
Practice Address - Street 1:100 E 5TH ST
Practice Address - Street 2:CQCH BILLING DEPT
Practice Address - City:DOUGLAS
Practice Address - State:AZ
Practice Address - Zip Code:85607-2859
Practice Address - Country:US
Practice Address - Phone:520-364-7659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23114208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ322214Medicaid
AZG15205Medicare UPIN
AZ77537Medicare ID - Type Unspecified