Provider Demographics
NPI:1306943576
Name:PAPADOPOULOS, XENOFON (MD)
Entity type:Individual
Prefix:
First Name:XENOFON
Middle Name:
Last Name:PAPADOPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 SAWGRASS AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-7605
Mailing Address - Country:US
Mailing Address - Phone:605-251-5386
Mailing Address - Fax:
Practice Address - Street 1:1900 GRASSLAND DR
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-6335
Practice Address - Country:US
Practice Address - Phone:605-995-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME117176208800000X
ND11033208800000X
MN48726208800000X
SD9532208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN388683000Medicaid
MN388683000Medicaid
FLHQ143ZMedicare PIN
MNI61180Medicare UPIN
MNI61180Medicare UPIN