Healthcare Provider Details

I. General information

NPI: 1053555912
Provider Name (Legal Business Name): NADIA VICKI GIANNAKOPOULOS MD PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF ALBERTA HOSPITAL 8440 112 STREET NW
EDMONTON AB
T6G 2B7
CA

IV. Provider business mailing address

10655 59 STREET NW
EDMONTON AB
T6A2K5
CA

V. Phone/Fax

Practice location:
  • Phone: 780-407-8822
  • Fax:
Mailing address:
  • Phone: 780-466-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberML60095933
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: