Provider Demographics
NPI:1720053705
Name:TRIANTAFYLLOS, JOHN T (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:TRIANTAFYLLOS
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 1:1221 PLEASANT ST
Mailing Address - Street 2:SUITE A100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1428
Mailing Address - Country:US
Mailing Address - Phone:515-241-4330
Mailing Address - Fax:
Practice Address - Street 1:1221 PLEASANT ST
Practice Address - Street 2:SUITE A100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1428
Practice Address - Country:US
Practice Address - Phone:515-241-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0834792085R0001X
IA376652085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG43448Medicare ID - Type Unspecified
CAG43448Medicare UPIN