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NPI Code Detail

MEDICARE: MRS. GEORGIA E PANOPOULOS PHD, LP

MEDICARE: MRS. GEORGIA E PANOPOULOS PHD, LP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistLP4025MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578537692
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GEORGIA E PANOPOULOS PHD, LP
Provider Business Mailing Address
First Line : 130 SUNRISE CT
Second Line :
City : MEDINA
State : MN
Zip : 55340-4554
Country : US
Telephone Number : 612-360-5108
Fax Number : 952-487-0483
Provider Business Practice Location Address
First Line : 7201 METRO BLVD STE 550
Second Line :
City : EDINA
State : MN
Zip : 55439-1353
Country : US
Telephone Number : 612-360-5108
Fax Number : 952-487-0483
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 09/13/2025

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