Provider Demographics
NPI:1245287879
Name:SARIDAKIS, GEORGE P (DO)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:SARIDAKIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2700
Mailing Address - Country:US
Mailing Address - Phone:440-743-8118
Mailing Address - Fax:216-201-4155
Practice Address - Street 1:1057 ROCKSIDE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2700
Practice Address - Country:US
Practice Address - Phone:440-743-8118
Practice Address - Fax:216-201-4155
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004883207Q00000X
OH34003324207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH042030OtherSELECT CARE
OH000000129203OtherANTHEM
OH080051444OtherRAILROAD MEDICARE
OH0247070001OtherADMINISTAR
OH110874OtherKAISER
OH341264676000EOtherAETNA
OH0491801Medicaid
OHSA0512914Medicare PIN
OH0512915Medicare PIN
OH000000129203OtherANTHEM
OH042030OtherSELECT CARE