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General NPI Number Information
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NPI Number | 1154826204
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Entity Type | Individual
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Provider Name | SPYROS MICHAEL SISCOS MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 2101 CHARLOTTE ST
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City | KANSAS CITY
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State | MO
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Zip | 64108-2727
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Country | US
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Telephone | 816-404-7810
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Fax |
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Provider Business Mailing Address
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Address Line | 1868 KELTON AVE APT 202
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City | LOS ANGELES
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State | CA
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Zip | 90025-6759
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Country | US
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Telephone | 913-744-9472
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A177736
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A177736
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 9409573
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 2023010353
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License Number State | MO
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