Provider Demographics
NPI:1467556019
Name:TSOUTSOURIS, THOMAS VLASIOS (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VLASIOS
Last Name:TSOUTSOURIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 INDIANAPOLIS BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46324-2941
Mailing Address - Country:US
Mailing Address - Phone:219-844-2020
Mailing Address - Fax:219-844-2088
Practice Address - Street 1:7330 INDIANAPOLIS BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46324-2941
Practice Address - Country:US
Practice Address - Phone:219-844-2020
Practice Address - Fax:219-844-2088
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN00700360213E00000X
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083565OtherANTHEM
T34738Medicare UPIN
IN388020Medicare PIN
IN000000083565OtherANTHEM