Provider Demographics
NPI:1790789428
Name:TSIOURIS, NIKOLAOS J (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAOS
Middle Name:J
Last Name:TSIOURIS
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 1:700 SHADOW LN
Mailing Address - Street 2:SUITE #240
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4158
Mailing Address - Country:US
Mailing Address - Phone:702-384-0022
Mailing Address - Fax:702-384-0529
Practice Address - Street 1:700 SHADOW LN
Practice Address - Street 2:SUITE #240
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4158
Practice Address - Country:US
Practice Address - Phone:702-384-0022
Practice Address - Fax:702-384-0529
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20030188207RC0000X, 207RC0001X
NV11945207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510003Medicaid
NV29278279Medicaid
NV100510003Medicaid
NV29278279Medicaid
103241Medicare PIN