Provider Demographics
NPI:1174677850
Name:ANATOLIOTAKIS, NIKOLAOS (MD)
Entity Type:Individual
Prefix:
First Name:NIKOLAOS
Middle Name:
Last Name:ANATOLIOTAKIS
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 1:5 ZOSIMADON ST
Mailing Address - Street 2:
Mailing Address - City:EGALEO
Mailing Address - State:ATHENS
Mailing Address - Zip Code:12243
Mailing Address - Country:GR
Mailing Address - Phone:210-598-0036
Mailing Address - Fax:
Practice Address - Street 1:5 ZOSIMADON ST
Practice Address - Street 2:
Practice Address - City:EGALEO
Practice Address - State:ATHENS
Practice Address - Zip Code:12243
Practice Address - Country:GR
Practice Address - Phone:210-598-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99206207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA641915241AMedicaid
FL2784793-00Medicaid
GA641915241AMedicaid
FLP00437451Medicare PIN