Provider Demographics
NPI:1477535953
Name:SMIRNAKIS, STELIOS MANOLIS (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:STELIOS
Middle Name:MANOLIS
Last Name:SMIRNAKIS
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BAYLOR PLZ RM SMITH517
Mailing Address - Street 2:BAYLOR COLLEGE OF MEDICINE
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3411
Mailing Address - Country:US
Mailing Address - Phone:781-974-9356
Mailing Address - Fax:713-798-2334
Practice Address - Street 1:6720 BERTNER AVE
Practice Address - Street 2:ST LUKE'S EPISCOPAL HOSPITAL, 7SOUTH
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:781-974-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2035952084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ24310OtherBCBS MA
MA0140597Medicaid
MA203595OtherTUFTS HEALTH PLAN
H51814Medicare UPIN
MA0140597Medicaid
8L18000Medicare PIN
TXTXB112746Medicare PIN