Healthcare Provider Details

I. General information

NPI: 1053769877
Provider Name (Legal Business Name): KYRIAKOS DALAMAGKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 MOURSUND AVE BLDG. G RM 115-118
HOUSTON TX
77030-5389
US

IV. Provider business mailing address

1331 MOURSUND AVE BLDG. G RM 115-118
HOUSTON TX
77030-5389
US

V. Phone/Fax

Practice location:
  • Phone: 713-799-5033
  • Fax: 713-797-5982
Mailing address:
  • Phone: 713-799-5033
  • Fax: 713-797-5982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.068153
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: