Healthcare Provider Details

I. General information

NPI: 1518966407
Provider Name (Legal Business Name): MICHAEL DEMETRIOS PAPPAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date: 03/20/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

4405 N HOLLAND SYLVANIA RD 102
TOLEDO OH
43623-2509
US

IV. Provider business mailing address

4405 N HOLLAND SYLVANIA RD 102
TOLEDO OH
43623-2509
US

V. Phone/Fax

Practice location:
  • Phone: 419-841-0772
  • Fax: 419-841-0894
Mailing address:
  • Phone: 419-841-0772
  • Fax: 419-841-0894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number66690
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number66690
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number81657
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: