Provider Demographics
NPI:1588698534
Name:TRIPODIS, KONSTANTINOS N (MD)
Entity type:Individual
Prefix:DR
First Name:KONSTANTINOS
Middle Name:N
Last Name:TRIPODIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:500 E OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91501-3316
Mailing Address - Country:US
Mailing Address - Phone:818-254-9967
Mailing Address - Fax:818-433-7242
Practice Address - Street 1:500 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91501-3316
Practice Address - Country:US
Practice Address - Phone:818-254-9967
Practice Address - Fax:818-433-7242
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA488672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF31915Medicare UPIN
CAWA48867BMedicare ID - Type Unspecified