Provider Demographics
NPI:1982901278
Name:XANTHAKOS, URSULA
Entity Type:Individual
Prefix:DR
First Name:URSULA
Middle Name:
Last Name:XANTHAKOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9717
Mailing Address - Country:US
Mailing Address - Phone:419-865-6548
Mailing Address - Fax:
Practice Address - Street 1:6811 HICKORY HILL DR
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9717
Practice Address - Country:US
Practice Address - Phone:419-865-6548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.032413208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics