Healthcare Provider Details

I. General information

NPI: 1659338440
Provider Name (Legal Business Name): DENNIS WILLIAM CAKOUROS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 PENLLYN PIKE
SPRING HOUSE PA
19477
US

IV. Provider business mailing address

PO BOX 161
SPRING HOUSE PA
19477-0161
US

V. Phone/Fax

Practice location:
  • Phone: 215-646-1725
  • Fax:
Mailing address:
  • Phone: 215-646-1725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS003302L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS003302L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000674787
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier052169
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBS HIGHMARK
# 3
Identifier0006747870008
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPROMISE
# 4
Identifier60126A
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE MERCY
# 5
Identifier0045119000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerKEYSTONE
# 6
Identifier052169
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: