Provider Demographics
NPI:1528021888
Name:NIKOLAIDIS, ANDREAS C (MD)
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:C
Last Name:NIKOLAIDIS
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 1:24375 FM 1314 RD
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4205
Mailing Address - Country:US
Mailing Address - Phone:281-354-5663
Mailing Address - Fax:281-354-1995
Practice Address - Street 1:24375 FM 1314 RD
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4205
Practice Address - Country:US
Practice Address - Phone:281-354-5663
Practice Address - Fax:281-354-1995
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3042208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0074HXOtherBLUECROSS BLUE SHIELD
TX00652FMedicare ID - Type Unspecified
0074HXOtherBLUECROSS BLUE SHIELD