Provider Demographics
NPI:1669578654
Name:CONSTANTINIDES, ALEXIOS-CLARK C (DO)
Entity type:Individual
Prefix:
First Name:ALEXIOS-CLARK
Middle Name:C
Last Name:CONSTANTINIDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:C
Other - Last Name:CONSTANTINIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:5265 N ACADEMY BLVD
Mailing Address - Street 2:STE 1800
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4060
Mailing Address - Country:US
Mailing Address - Phone:719-599-0444
Mailing Address - Fax:719-599-8809
Practice Address - Street 1:5265 N ACADEMY BLVD
Practice Address - Street 2:STE 1800
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4060
Practice Address - Country:US
Practice Address - Phone:719-599-0444
Practice Address - Fax:719-599-8809
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC803641Medicare PIN
COH49594Medicare UPIN