Provider Demographics
NPI:1609968536
Name:KOUTSOYIANNIS, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KOUTSOYIANNIS
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 1:42 70 156TH STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355
Mailing Address - Country:US
Mailing Address - Phone:718-353-1020
Mailing Address - Fax:718-353-1024
Practice Address - Street 1:42 70 156TH STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-353-1020
Practice Address - Fax:718-353-1024
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY132290207RN0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics