Healthcare Provider Details

I. General information

NPI: 1982414017
Provider Name (Legal Business Name): MICHAEL DIMITRI YALLOURAKIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3188 BELLEVUE AVE
CINCINNATI OH
45219-2369
US

IV. Provider business mailing address

340 W 10TH ST STE 6200
INDIANAPOLIS IN
46202-3082
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-1000
  • Fax:
Mailing address:
  • Phone: 317-274-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number57.260754
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: