Provider Demographics
NPI:1265454235
Name:XENOS, ELEFTHERIOS SARANTIS (MD)
Entity type:Individual
Prefix:
First Name:ELEFTHERIOS
Middle Name:SARANTIS
Last Name:XENOS
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 1:800 ROSE ST
Mailing Address - Street 2:C218
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0293
Mailing Address - Country:US
Mailing Address - Phone:859-323-6346
Mailing Address - Fax:
Practice Address - Street 1:740 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0293
Practice Address - Country:US
Practice Address - Phone:859-257-3253
Practice Address - Fax:859-323-6840
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY403872086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64127640Medicaid
KY40387OtherMEDICAL LICENSE
KY64127640Medicaid
KYXE7323421Medicare PIN
KY40387OtherMEDICAL LICENSE
OHXE4136321Medicare ID - Type Unspecified