Provider Demographics
NPI:1922245901
Name:STAVROPOULOS, YANNIS M (MD)
Entity Type:Individual
Prefix:
First Name:YANNIS
Middle Name:M
Last Name:STAVROPOULOS
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 1:6061 N 1ST ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5470
Mailing Address - Country:US
Mailing Address - Phone:559-449-7668
Mailing Address - Fax:559-449-0641
Practice Address - Street 1:6061 N 1ST ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5470
Practice Address - Country:US
Practice Address - Phone:559-449-7668
Practice Address - Fax:559-449-0641
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35642174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35642OtherMEDICAL BOARD OF CALIFORNIA
CAA35642OtherMEDICAL BOARD OF CALIFORNIA
00A356420Medicare PIN