Provider Demographics
NPI:1497337786
Name:PAPPAS, FOTIS G (MD)
Entity Type:Individual
Prefix:
First Name:FOTIS
Middle Name:G
Last Name:PAPPAS
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 1:405 BILLINGS CT
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-8307
Mailing Address - Country:US
Mailing Address - Phone:815-762-7740
Mailing Address - Fax:
Practice Address - Street 1:16 GUION PL
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5502
Practice Address - Country:US
Practice Address - Phone:815-762-7740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program