Provider Demographics
NPI:1275673220
Name:POULOS, CHRISTOPHER KREAG (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KREAG
Last Name:POULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5720 FOREST PARK RD
Mailing Address - Street 2:APT 3216
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-6420
Mailing Address - Country:US
Mailing Address - Phone:214-366-2270
Mailing Address - Fax:
Practice Address - Street 1:5230 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7710
Practice Address - Country:US
Practice Address - Phone:214-920-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061116A207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01061116AOtherSTATE LICENSE
TX524557OtherPOSTGRAD TRAINING PERMIT