Provider Demographics
NPI:1508854225
Name:LEKKOS, APOSTOLOS ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:APOSTOLOS
Middle Name:ANTHONY
Last Name:LEKKOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 RAMBLA PACIFICO
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5143
Mailing Address - Country:US
Mailing Address - Phone:972-768-8693
Mailing Address - Fax:
Practice Address - Street 1:15107 VANOWEN ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:310-955-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-06
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8934207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148152502Medicaid
TX148152503OtherCSHCN
TX8F8190OtherBCBS
TX148152502Medicaid
TX930121376Medicare PIN
TX8066J5Medicare PIN