Provider Demographics
NPI:1902889793
Name:PSIHRAMIS, KOSTANTINOS ELIAS (MD)
Entity type:Individual
Prefix:DR
First Name:KOSTANTINOS
Middle Name:ELIAS
Last Name:PSIHRAMIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:301 W LINCOLN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-1901
Mailing Address - Country:US
Mailing Address - Phone:618-641-5803
Mailing Address - Fax:618-641-5813
Practice Address - Street 1:3 SAINT ELIZABETH BLVD STE 5000
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1282
Practice Address - Country:US
Practice Address - Phone:618-641-5803
Practice Address - Fax:618-641-5116
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036114858208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILBP3415379OtherDEA #
ILB98882Medicare UPIN