Healthcare Provider Details

I. General information

NPI: 1104877828
Provider Name (Legal Business Name): GEORGIOS FILIADIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 S MAIN ST
ANDOVER OH
44003-9602
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 130- PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-4000
  • Fax: 330-656-5901
Mailing address:
  • Phone: 330-656-5911
  • Fax: 317-962-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02004003A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34008624
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: