Provider Demographics
NPI:1912980194
Name:JAMOULIS, SOCRATES C (MD)
Entity Type:Individual
Prefix:
First Name:SOCRATES
Middle Name:C
Last Name:JAMOULIS
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:PO BOX 414975
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-4975
Mailing Address - Country:US
Mailing Address - Phone:816-455-0661
Mailing Address - Fax:816-454-1080
Practice Address - Street 1:9501 N OAK TRFY
Practice Address - Street 2:#100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-2256
Practice Address - Country:US
Practice Address - Phone:816-455-0661
Practice Address - Fax:816-454-1080
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1433882085R0202X
KS233692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204795108Medicaid
2267634OtherAETNA
KS100124320CMedicaid
MO26323071OtherBCBS
C87508Medicare UPIN
MO337A273BMedicare ID - Type Unspecified
KS100124320CMedicaid