Basic Information
| Provider Information | |||||||||
| NPI: | 1518037928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RADEOS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | STAVROS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1922 COLDEN AVE | ||||||||
| Address2: | APARTMENT # 2 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104623159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795370 | ||||||||
| FaxNumber: | 7185794822 | ||||||||
| Practice Location | |||||||||
| Address1: | 234 E 149TH ST | ||||||||
| Address2: | ROOM 1-685 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104515504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185795370 | ||||||||
| FaxNumber: | 7185794822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 163814 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.