Provider Demographics
NPI:1013112051
Name:GALANIS, TAKI (MD)
Entity Type:Individual
Prefix:DR
First Name:TAKI
Middle Name:
Last Name:GALANIS
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 1:111 S 11TH ST
Mailing Address - Street 2:SUITE 6270
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4824
Mailing Address - Country:US
Mailing Address - Phone:215-955-6540
Mailing Address - Fax:215-503-2203
Practice Address - Street 1:111 S 11TH ST
Practice Address - Street 2:SUITE 6270
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4824
Practice Address - Country:US
Practice Address - Phone:215-955-6540
Practice Address - Fax:215-503-2203
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD431089207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101942929Medicaid
NJ0135674Medicaid
PA112210Medicare PIN