Provider Demographics
NPI:1194823096
Name:CONSTANTINIDES, MINAS SPIROS (MD)
Entity Type:Individual
Prefix:DR
First Name:MINAS
Middle Name:SPIROS
Last Name:CONSTANTINIDES
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 1:3800 N LAMAR BLVD STE 155
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-0002
Mailing Address - Country:US
Mailing Address - Phone:512-617-9200
Mailing Address - Fax:512-666-3765
Practice Address - Street 1:3800 N LAMAR BLVD STE 155
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-0002
Practice Address - Country:US
Practice Address - Phone:512-617-9200
Practice Address - Fax:512-553-1055
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ5991207Y00000X, 207YS0123X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX442293YS4ZMedicare PIN