Provider Demographics
NPI:1528032786
Name:PANAGOPOULOS, DIMITRIOS (DPM)
Entity Type:Individual
Prefix:DR
First Name:DIMITRIOS
Middle Name:
Last Name:PANAGOPOULOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24025 GREATER MACK AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1486
Mailing Address - Country:US
Mailing Address - Phone:313-884-7566
Mailing Address - Fax:313-884-3140
Practice Address - Street 1:24025 GREATER MACK AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1486
Practice Address - Country:US
Practice Address - Phone:313-884-7566
Practice Address - Fax:313-884-3140
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002021213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4476009Medicaid
MI0N92390Medicare ID - Type Unspecified
MI4476009Medicaid