Provider Demographics
NPI:1790781730
Name:KALOVIDOURIS, APOSTOLOS EMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:APOSTOLOS
Middle Name:EMIL
Last Name:KALOVIDOURIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2109 DOCTORS PARK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-2224
Mailing Address - Country:US
Mailing Address - Phone:812-348-4080
Mailing Address - Fax:812-348-4090
Practice Address - Street 1:2109 DOCTORS PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2224
Practice Address - Country:US
Practice Address - Phone:812-348-4080
Practice Address - Fax:812-348-4090
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028509A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100061650BMedicaid
IN144940Medicare ID - Type Unspecified
IN100061650BMedicaid