Healthcare Provider Details

I. General information

NPI: 1770610180
Provider Name (Legal Business Name): DEMETRIOS KATSAROS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7863 BROADWAY SUITE 135
MERRILLVILLE IN
46410-5553
US

IV. Provider business mailing address

4503 THORNBURY DR E
VALPARAISO IN
46383-0813
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-2047
  • Fax: 219-736-2048
Mailing address:
  • Phone: 219-549-0837
  • Fax: 219-548-0857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01049411
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: