Provider Demographics
NPI:1659479327
Name:KREATSOULAS, NICHOLAS CHRIS (DO)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CHRIS
Last Name:KREATSOULAS
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 1:1044 BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1006
Mailing Address - Country:US
Mailing Address - Phone:330-480-2949
Mailing Address - Fax:330-480-2071
Practice Address - Street 1:1044 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504
Practice Address - Country:US
Practice Address - Phone:330-480-2949
Practice Address - Fax:330-480-2071
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.005309207PH0002X
OH34-005309207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0937786Medicaid
OH0937786Medicaid
F65754Medicare UPIN