Provider Demographics
NPI:1235106436
Name:DEMOU, CONSTANTINA (DPM)
Entity Type:Individual
Prefix:
First Name:CONSTANTINA
Middle Name:
Last Name:DEMOU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012-0203
Mailing Address - Country:US
Mailing Address - Phone:440-930-2503
Mailing Address - Fax:440-930-4340
Practice Address - Street 1:516 VINTAGE PT
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012-4109
Practice Address - Country:US
Practice Address - Phone:440-930-2503
Practice Address - Fax:440-930-4340
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003147213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2312607Medicaid
OH2312607Medicaid