Healthcare Provider Details

I. General information

NPI: 1710972864
Provider Name (Legal Business Name): DEMOSTHENES N ISKOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 FRANCE AVE S SUITE W200
EDINA MN
55435-2163
US

IV. Provider business mailing address

6405 FRANCE AVE S SUITE W200
EDINA MN
55435-2163
US

V. Phone/Fax

Practice location:
  • Phone: 952-915-2454
  • Fax:
Mailing address:
  • Phone: 952-915-2454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number185113-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number185113-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number41933
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: