Provider Demographics
NPI:1679784979
Name:MYKONIATIS, ANDREAS (MD)
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:
Last Name:MYKONIATIS
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 1:5600 S QUEBEC STREET
Mailing Address - Street 2:SUITE 312A
Mailing Address - City:GREENWOOD VILLIAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2208
Mailing Address - Country:US
Mailing Address - Phone:720-754-2296
Mailing Address - Fax:844-669-1725
Practice Address - Street 1:1719 E 19TH AVE
Practice Address - Street 2:IM HOSPITALIST
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1235
Practice Address - Country:US
Practice Address - Phone:720-754-2296
Practice Address - Fax:844-669-1725
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119322207R00000X, 208M00000X
CODR.0056350207R00000X
CO56350208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58685057Medicaid
F400291996OtherMEDICARE PTAN
CO534644YM4QMedicare PIN