Provider Demographics
NPI:1750531034
Name:SOULIOTIS, NOLASKA I (DPM)
Entity type:Individual
Prefix:
First Name:NOLASKA
Middle Name:I
Last Name:SOULIOTIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NOLASKA
Other - Middle Name:I
Other - Last Name:TARDENCILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:12221 N MOPAC EXPY
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2401
Mailing Address - Country:US
Mailing Address - Phone:512-901-4015
Mailing Address - Fax:512-901-3935
Practice Address - Street 1:12221 N MOPAC EXPY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2401
Practice Address - Country:US
Practice Address - Phone:512-901-4015
Practice Address - Fax:512-901-3935
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1985213E00000X, 213ES0103X, 213ES0131X
IL016.005371213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00986695OtherRAILROAD MEDICARE
TX285495201Medicaid
TX285495201Medicaid