MEDICARE: DR. KONSTANTINOS GUS KALLINIKOS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	N005435	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480034729	OTHER	NY	MEDICARE RAILROAD
4	03655	OTHER	NY	GHI MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4C0018	OTHER	NY	PHS
3	P1946748	OTHER	NY	OXFORD
5	N005435	OTHER	NY	HIP
6	161148	OTHER	NC	ELDERPLAN
7	2700985	OTHER	NY	EVERCARE
8	6201697	OTHER	NY	GHI
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	1902861	OTHER	NY	UNITED HEALTH CARE

General Provider Information

NPI Number	:	1073505343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KONSTANTINOS GUS KALLINIKOS DPM

Provider Business Mailing Address
First Line	:	532 NEPTUNE AVE
Second Line	:	SUITE 203
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4010
Country	:	US
Telephone Number	:	718-996-6000
Fax Number	:	718-996-6019

Provider Business Practice Location Address
First Line	:	525 NEPTUNE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4063
Country	:	US
Telephone Number	:	718-996-6000
Fax Number	:	718-996-6019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	01/12/2017

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Directions to “ DR. KONSTANTINOS GUS KALLINIKOS DPM” Practice Location

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