Healthcare Provider Details

I. General information

NPI: 1043268741
Provider Name (Legal Business Name): ELIAS D. STRATIGOULEAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 N CRAYCROFT RD BLDG 5
TUCSON AZ
85712-2801
US

IV. Provider business mailing address

2121 N CRAYCROFT RD BLDG 5
TUCSON AZ
85712-2801
US

V. Phone/Fax

Practice location:
  • Phone: 520-296-8500
  • Fax: 520-733-2389
Mailing address:
  • Phone: 520-296-8500
  • Fax: 520-733-2389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35227
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: