Provider Demographics
NPI:1689997256
Name:CHRYSANTHAKOPOULOS, KATERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATERINE
Middle Name:
Last Name:CHRYSANTHAKOPOULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATERINA
Other - Middle Name:
Other - Last Name:CHRYSANTHAKOPOULOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5850 W WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4904
Mailing Address - Country:US
Mailing Address - Phone:405-721-6662
Mailing Address - Fax:405-721-8417
Practice Address - Street 1:5850 W WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-4904
Practice Address - Country:US
Practice Address - Phone:405-721-6662
Practice Address - Fax:405-721-8417
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12377291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory