Provider Demographics
NPI:1932143708
Name:NIKOLAIDIS, ELEFTERIOS T (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEFTERIOS
Middle Name:T
Last Name:NIKOLAIDIS
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 1:2755 S BAY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6587
Mailing Address - Country:US
Mailing Address - Phone:352-253-3374
Mailing Address - Fax:352-589-4140
Practice Address - Street 1:1000 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5266
Practice Address - Country:US
Practice Address - Phone:352-253-3374
Practice Address - Fax:352-343-7010
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0040164207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036153400Medicaid
FL036153400Medicaid
FLD70683Medicare UPIN