Healthcare Provider Details

I. General information

NPI: 1356692339
Provider Name (Legal Business Name): MILTIADIS DOUVOYIANNIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 S COLUMBIA RD
GRAND FORKS ND
58201-4059
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-795-2000
  • Fax: 701-780-4477
Mailing address:
  • Phone: 701-780-1891
  • Fax: 701-780-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number12926
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12926
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: