Provider Demographics
NPI:1649202250
Name:PAPPAS, SPILIOS JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:SPILIOS
Middle Name:JOHN
Last Name:PAPPAS
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 1:3011 W GRAND BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-3096
Mailing Address - Country:US
Mailing Address - Phone:313-832-8008
Mailing Address - Fax:313-832-8007
Practice Address - Street 1:3011 W GRAND BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3096
Practice Address - Country:US
Practice Address - Phone:313-832-8008
Practice Address - Fax:313-832-8007
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-063491207P00000X
MI4301052677207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0898471Medicaid
OH0898471Medicaid
OHE82118Medicare UPIN