MEDICARE: DIMITRIOS SPIROS MANTZOROS 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	213ES0103X	Foot & Ankle Surgery Podiatrist	1068	TX
2	213E00000X	Podiatrist	1068	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285660803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMITRIOS SPIROS MANTZOROS DPM

Provider Business Mailing Address
First Line	:	1020 RIVERWOOD CT STE 220
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2974
Country	:	US
Telephone Number	:	936-756-9191
Fax Number	:	936-756-9197

Provider Business Practice Location Address
First Line	:	1020 RIVERWOOD CT STE 220
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2974
Country	:	US
Telephone Number	:	936-756-9191
Fax Number	:	936-756-9197

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

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	12/27/2024

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Directions to “ DIMITRIOS SPIROS MANTZOROS DPM” Practice Location

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