Provider Demographics
NPI:1447394903
Name:THOMARIOS, NICKITAS BERNARD-ARISTIDES (DO)
Entity Type:Individual
Prefix:
First Name:NICKITAS
Middle Name:BERNARD-ARISTIDES
Last Name:THOMARIOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 E 26TH ST
Mailing Address - Street 2:STE 410; MS 40-410
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-4526
Mailing Address - Country:US
Mailing Address - Phone:612-813-7179
Mailing Address - Fax:
Practice Address - Street 1:910 E 26TH ST
Practice Address - Street 2:STE 410; MS 40-410
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4526
Practice Address - Country:US
Practice Address - Phone:612-813-7179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN185622084P0800X
MN496242084P0800X
NC2012-003142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry