Healthcare Provider Details

I. General information

NPI: 1922072826
Provider Name (Legal Business Name): NICHOLAS KARYOTAKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK EAST #1206
LOS ANGELES CA
90067
US

IV. Provider business mailing address

9589 STUART LANE
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-282-0525
  • Fax: 310-201-0662
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA 61044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: