MEDICARE: DR. DIMITRIOS GIANNAKIDIS MD

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	2084N0400X	Neurology Physician	63778	WI
2	2084N0400X	Neurology Physician	MD041347	DC
3	2084N0400X	Neurology Physician	01098339A	IN
4	2084N0400X	Neurology Physician	25IA12491300	NJ
5	2084N0400X	Neurology Physician	57399	MN
6	2084N0400X	Neurology Physician	0101276175	VA
7	2084V0102X	Vascular Neurology Physician	57399	MN
8	2084N0400X	Neurology Physician	C171628	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10546	OTHER	SD	MEDICAL LICENSE
2	MD041347	OTHER	DC	MEDICAL LICENSE
3	63778-20	OTHER	WI	MEDICAL LICENSE
4	57399	OTHER	MN	MEDICAL LICENSE
5	C171628	OTHER	CA	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1285963793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIMITRIOS GIANNAKIDIS MD

Provider Business Mailing Address
First Line	:	325 DISTEL CIR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1408
Country	:	US
Telephone Number	:	156-005-7604
Fax Number	:	415-369-1208

Provider Business Practice Location Address
First Line	:	1100 VAN NESS AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-6978
Country	:	US
Telephone Number	:	415-600-5760
Fax Number	:	415-369-1208

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

Provider Enumeration Date	:	12/11/2009
Last Update Date	:	12/16/2025

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