Provider Demographics
NPI:1427219120
Name:NICOLAOU, DAEMEON ACHILLES (MD)
Entity Type:Individual
Prefix:
First Name:DAEMEON
Middle Name:ACHILLES
Last Name:NICOLAOU
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 1:1008 S. SPRING ST.
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:310-977-5330
Mailing Address - Fax:314-268-5121
Practice Address - Street 1:3635 VISTA AVE
Practice Address - Street 2:7TH FLOOR DESLOGE TOWERS
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110
Practice Address - Country:US
Practice Address - Phone:314-577-8850
Practice Address - Fax:314-268-5121
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013021987207X00000X
MO201301987390200000X
CA390200000X
CAA111473207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program