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General NPI Number Information
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NPI Number | 1407868706
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Entity Type | Individual
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Provider Name | EFTHIMIOS ALEXANDER BAKALAKOS M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 112 SAINT OLAF AVE S
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City | CANBY
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State | MN
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Zip | 56220-1433
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Country | US
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Telephone | 507-223-7277
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Fax | 507-223-7465
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Provider Business Mailing Address
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Address Line | PO BOX 5074
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City | SIOUX FALLS
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State | SD
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Zip | 57117-5074
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Country | US
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Telephone | 605-328-9419
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Fax | 507-223-7465
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 41801
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License Number State | MN
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