Provider Demographics
NPI:1154826204
Name:SISCOS, SPYROS MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SPYROS
Middle Name:MICHAEL
Last Name:SISCOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:SISCOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1868 KELTON AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6759
Mailing Address - Country:US
Mailing Address - Phone:913-744-9472
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PLAZA DRIVEWAY SUITE 465
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:913-744-9472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA177736207N00000X, 207ND0101X
KS9409573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine