Basic Information
| Provider Information | |||||||||
| NPI: | 1043521644 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANTONOPOULOS | ||||||||
| FirstName: | KOSTA | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.P.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5885 SUNNYBROOK DR | ||||||||
| Address2: | STE E-100 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122662700 | ||||||||
| FaxNumber: | 7122662718 | ||||||||
| Practice Location | |||||||||
| Address1: | 5885 SUNNYBROOK DR | ||||||||
| Address2: | STE E-100 | ||||||||
| City: | SIOUX CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 511064203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7122662700 | ||||||||
| FaxNumber: | 7122662718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2010 | ||||||||
| LastUpdateDate: | 07/27/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | SC006184 | PA | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | 213ES0103X | 000869 | IA | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.