Provider Demographics
NPI:1336342799
Name:NIKOLAKEAS, KRISTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:NIKOLAKEAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1728
Mailing Address - Country:US
Mailing Address - Phone:810-742-5700
Mailing Address - Fax:810-742-6062
Practice Address - Street 1:1513 S CENTER RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1728
Practice Address - Country:US
Practice Address - Phone:810-742-5700
Practice Address - Fax:810-742-6062
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM23560233Medicare PIN