Provider Demographics
NPI:1598285173
Name:KYRIAKAKIS, ROXANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:
Last Name:KYRIAKAKIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MICHIGAN ST NE STE 200-A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2543
Mailing Address - Country:US
Mailing Address - Phone:616-391-1405
Mailing Address - Fax:616-391-8611
Practice Address - Street 1:221 MICHIGAN ST NE STE 200-A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-2543
Practice Address - Country:US
Practice Address - Phone:616-391-1405
Practice Address - Fax:616-391-8611
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301506900208C00000X, 208600000X
MI4301112945208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery