Provider Demographics
NPI:1558354159
Name:RAPHTIS, CONSTANTINE (DO)
Entity Type:Individual
Prefix:DR
First Name:CONSTANTINE
Middle Name:
Last Name:RAPHTIS
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 1:19714 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1064
Mailing Address - Country:US
Mailing Address - Phone:586-779-9400
Mailing Address - Fax:586-779-8949
Practice Address - Street 1:19714 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1064
Practice Address - Country:US
Practice Address - Phone:586-779-9400
Practice Address - Fax:586-779-8949
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010924207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4325630Medicaid
MI4325630Medicaid
F88560Medicare UPIN