Provider Demographics
NPI:1376868232
Name:ANDREAS C NIKOLAIDIS, MD, PA
Entity Type:Organization
Organization Name:ANDREAS C NIKOLAIDIS, MD, PA
Other - Org Name:ANDREAS C NIKOLAIDIS, MD, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:NIKOLAIDIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-354-5663
Mailing Address - Street 1:24375 FM 1314 RD
Mailing Address - Street 2:PO BOX 734
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4205
Mailing Address - Country:US
Mailing Address - Phone:281-354-5663
Mailing Address - Fax:281-354-1995
Practice Address - Street 1:24375 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4205
Practice Address - Country:US
Practice Address - Phone:281-354-5663
Practice Address - Fax:281-354-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3042208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151052102Medicaid
TX151052103Medicaid
TX151052101Medicaid
TXH62730Medicare UPIN
TX151052101Medicaid