Provider Demographics
NPI:1710394325
Name:THEODOROPOULOS, KLEANTHIS (MD , PHD)
Entity Type:Individual
Prefix:
First Name:KLEANTHIS
Middle Name:
Last Name:THEODOROPOULOS
Suffix:
Gender:M
Credentials:MD , PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:212-305-4600
Mailing Address - Fax:212-305-7439
Practice Address - Street 1:622 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3720
Practice Address - Country:US
Practice Address - Phone:212-305-4600
Practice Address - Fax:212-305-7439
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY296675207R00000X, 208M00000X, 207RA0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist