Provider Demographics
NPI:1821070798
Name:TAPAZOGLOU, EFSTATHIOS S (MD)
Entity Type:Individual
Prefix:DR
First Name:EFSTATHIOS
Middle Name:S
Last Name:TAPAZOGLOU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11900 E 12 MILE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3400
Mailing Address - Country:US
Mailing Address - Phone:586-558-4700
Mailing Address - Fax:586-558-4706
Practice Address - Street 1:11900 E 12 MILE RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3400
Practice Address - Country:US
Practice Address - Phone:586-558-4700
Practice Address - Fax:586-558-4706
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIET040673207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIET040673OtherLICENSE NUMBER
MIB49272Medicare UPIN