1194965558 NPI number — MS. THEODORA KOKTSIDIS HEALTH ADMINISTRATOR

Table of content: MS. THEODORA KOKTSIDIS HEALTH ADMINISTRATOR (NPI 1194965558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194965558 NPI number — MS. THEODORA KOKTSIDIS HEALTH ADMINISTRATOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOKTSIDIS
Provider First Name:
THEODORA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
HEALTH ADMINISTRATOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOKTSIDIS
Provider Other First Name:
THEODORA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MEDICAL ASSISTANT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194965558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
346 FOX TRAIL CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOBART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46342-2351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-677-7018
Provider Business Mailing Address Fax Number:
219-940-9429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
346 FOX TRAIL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46342-2351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-677-7018
Provider Business Practice Location Address Fax Number:
219-940-9429
Provider Enumeration Date:
02/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 172V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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