Provider Demographics
NPI:1306027164
Name:COSTAS L. CONSTANTINOU, M.D., P.C
Entity Type:Organization
Organization Name:COSTAS L. CONSTANTINOU, M.D., P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COSTAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:CONSTANTINOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-359-9876
Mailing Address - Street 1:1409 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1923
Mailing Address - Country:US
Mailing Address - Phone:563-359-9876
Mailing Address - Fax:563-359-0608
Practice Address - Street 1:1409 E KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1923
Practice Address - Country:US
Practice Address - Phone:563-359-9876
Practice Address - Fax:563-359-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3217588Medicaid
IAI16775Medicare PIN
IL212920Medicare PIN