Provider Demographics
NPI:1407045602
Name:PAPAKONSTANTINOU, NICHOLAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:S
Last Name:PAPAKONSTANTINOU
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 1:1555 SOUTH BLVD E STE 310
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5624
Mailing Address - Country:US
Mailing Address - Phone:248-215-8095
Mailing Address - Fax:248-289-6907
Practice Address - Street 1:1555 SOUTH BLVD E STE 310
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5624
Practice Address - Country:US
Practice Address - Phone:248-215-8095
Practice Address - Fax:248-289-6907
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.012616207X00000X
MINP082055207XS0117X
MI4301082055207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200922840Medicaid
MI200922840Medicaid
MIOMO4540Medicare PIN