MEDICARE: DR. FOTINI MARIA CHALKIAS M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207UN0901X	Nuclear Cardiology Physician	M5092	TX
2	207RC0000X	Cardiovascular Disease Physician	M5092	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P01040680	OTHER	TX	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8CU861	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	8ET189	OTHER	TX	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1518065317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FOTINI MARIA CHALKIAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:	800-944-0371
Fax Number	:	254-215-9722

Provider Business Practice Location Address
First Line	:	2608 BROCKTON DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78758-4414
Country	:	US
Telephone Number	:	512-654-4050
Fax Number	:

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/21/2023