Provider Demographics
NPI:1407004880
Name:SARLIS, DEMOSTHENES N (MD)
Entity Type:Individual
Prefix:DR
First Name:DEMOSTHENES
Middle Name:N
Last Name:SARLIS
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 1:286 US HIGHWAY 23 N
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8732
Mailing Address - Country:US
Mailing Address - Phone:606-874-0032
Mailing Address - Fax:606-874-0817
Practice Address - Street 1:286 US HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-8732
Practice Address - Country:US
Practice Address - Phone:606-874-0032
Practice Address - Fax:606-874-0817
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME102734208100000X
GA64722208100000X
KY44283208VP0000X, 2081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003101267DMedicaid
KY7100220230Medicaid
KY000000790378OtherANTHEM PIN
KY000000790378OtherANTHEM PIN
KYK072960Medicare PIN
GA003101267DMedicaid
GA202I253861Medicare PIN