MEDICARE: STYLIANOS A KAKOULLIS 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	39172	TN

General Provider Information

NPI Number	:	1770586679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STYLIANOS A KAKOULLIS MD

Provider Business Mailing Address
First Line	:	330 FRANKLIN RD
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-3280
Country	:	US
Telephone Number	:	615-309-3300
Fax Number	:	615-309-3339

Provider Business Practice Location Address
First Line	:	705 HOWELL ST
Second Line	:	STE B
City	:	SPARTA
State	:	TN
Zip	:	38583-1008
Country	:	US
Telephone Number	:	931-738-4595
Fax Number	:	931-738-4596

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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