Provider Demographics
NPI:1659338440
Name:CAKOUROS, DENNIS WILLIAM (DO)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:WILLIAM
Last Name:CAKOUROS
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:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-0161
Mailing Address - Country:US
Mailing Address - Phone:215-646-1725
Mailing Address - Fax:
Practice Address - Street 1:716 PENLLYN PIKE
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477
Practice Address - Country:US
Practice Address - Phone:215-646-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003302L207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000674787Medicaid
PA052169OtherBS HIGHMARK
PA0006747870008OtherPROMISE
PA60126AOtherKEYSTONE MERCY
PA0045119000OtherKEYSTONE
PA052169OtherBS
PA000674787Medicaid
PA052169JFGMedicare PIN
PA052169OtherBS HIGHMARK