Provider Demographics
NPI:1407868706
Name:BAKALAKOS, EFTHIMIOS ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:EFTHIMIOS
Middle Name:ALEXANDER
Last Name:BAKALAKOS
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-9419
Mailing Address - Fax:507-223-7465
Practice Address - Street 1:112 SAINT OLAF AVE S
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:MN
Practice Address - Zip Code:56220-1433
Practice Address - Country:US
Practice Address - Phone:507-223-7277
Practice Address - Fax:507-223-7465
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41801208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN258716500Medicaid