Healthcare Provider Details

I. General information

NPI: 1740258128
Provider Name (Legal Business Name): MICHAEL T BARKOUKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 PEARL RD SUITE 200
CLEVELAND OH
44130-3639
US

IV. Provider business mailing address

6900 PEARL RD SUITE 200
CLEVELAND OH
44130-3639
US

V. Phone/Fax

Practice location:
  • Phone: 440-845-0900
  • Fax: 440-845-7355
Mailing address:
  • Phone: 440-845-0900
  • Fax: 440-845-7355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35045849B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: