Provider Demographics
NPI:1518966407
Name:PAPPAS, MICHAEL DEMETRIOS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEMETRIOS
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 1:4405 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:102
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2509
Mailing Address - Country:US
Mailing Address - Phone:419-841-0772
Mailing Address - Fax:419-841-0894
Practice Address - Street 1:4405 N HOLLAND SYLVANIA RD
Practice Address - Street 2:102
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2509
Practice Address - Country:US
Practice Address - Phone:419-841-0772
Practice Address - Fax:419-841-0894
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
OH66690208000000X, 2080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0971122Medicaid
OHF81208Medicare UPIN