Provider Demographics
NPI:1518159557
Name:SOUSLIAN, FOTIS GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:FOTIS
Middle Name:GREGORY
Last Name:SOUSLIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1601 E 19TH AVE STE 6100
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1255
Mailing Address - Country:US
Mailing Address - Phone:303-414-2330
Mailing Address - Fax:303-945-7856
Practice Address - Street 1:1601 E 19TH AVE STE 6100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1255
Practice Address - Country:US
Practice Address - Phone:303-414-2330
Practice Address - Fax:303-945-7856
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI69713207T00000X
MN20456207T00000X
CODR.0061728207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery