Provider Demographics
NPI:1912904970
Name:PAPPAS, ANASTASIOS ANGELO (MD)
Entity Type:Individual
Prefix:MR
First Name:ANASTASIOS
Middle Name:ANGELO
Last Name:PAPPAS
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 1:535 DAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1709
Mailing Address - Country:US
Mailing Address - Phone:513-548-1056
Mailing Address - Fax:
Practice Address - Street 1:400 SELBY AVE STE S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-4520
Practice Address - Country:US
Practice Address - Phone:952-373-4123
Practice Address - Fax:651-383-4947
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI51009207N00000X
SD4426207N00000X
MN41400207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5900330Medicaid
MN70000922Medicare PIN