Provider Demographics
NPI:1780793661
Name:DOUKIDES, PANAGIOTIS THEODORE (MD)
Entity type:Individual
Prefix:
First Name:PANAGIOTIS
Middle Name:THEODORE
Last Name:DOUKIDES
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 1:4027 NORTH HOLLAND-SYLVANIA ROAD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO,
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2592
Mailing Address - Country:US
Mailing Address - Phone:419-824-9993
Mailing Address - Fax:419-824-9962
Practice Address - Street 1:4027 N HOLLAND SYLVANIA RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-2592
Practice Address - Country:US
Practice Address - Phone:419-824-9993
Practice Address - Fax:419-824-9962
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 0470292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0499401Medicaid
OH0518524OtherMEDICARE ID UNSPECIFIED
OH0499401Medicaid