Provider Demographics
NPI:1588966642
Name:XANTHAKOS, DIMITRIOS N (MD)
Entity type:Individual
Prefix:DR
First Name:DIMITRIOS
Middle Name:N
Last Name:XANTHAKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6811 HICKORY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9717
Mailing Address - Country:US
Mailing Address - Phone:419-865-6548
Mailing Address - Fax:419-865-6528
Practice Address - Street 1:6811 HICKORY HILL DR
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9717
Practice Address - Country:US
Practice Address - Phone:419-865-6548
Practice Address - Fax:419-865-6528
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.032414208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery