Basic Information
| Provider Information | |||||||||
| NPI: | 1770586679 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAKOULLIS | ||||||||
| FirstName: | STYLIANOS | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 FRANKLIN RD | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370273280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153093300 | ||||||||
| FaxNumber: | 6153093339 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 HOWELL ST | ||||||||
| Address2: | STE B | ||||||||
| City: | SPARTA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385831008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317384595 | ||||||||
| FaxNumber: | 9317384596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 39172 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.