Basic Information
Provider Information
NPI: 1780145979
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAVVIDES
FirstName: CHRISTOPHER
MiddleName: ANDREAS
NamePrefix: MR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2504 EAGLES CIR UNIT 6
Address2:  
City: YPSILANTI
State: MI
PostalCode: 481971573
CountryCode: US
TelephoneNumber: 7347090567
FaxNumber:  
Practice Location
Address1: 5333 MCAULEY DR RM 4001
Address2:  
City: YPSILANTI
State: MI
PostalCode: 481971099
CountryCode: US
TelephoneNumber: 7347123980
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/29/2019
LastUpdateDate: 03/29/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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