Basic Information
| Provider Information | |||||||||
| NPI: | 1992762736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KYRIAKEDES | ||||||||
| FirstName: | CHRIST | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 WABASH AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303446326 | ||||||||
| FaxNumber: | 3302538293 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 WABASH AVE | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303441799 | ||||||||
| FaxNumber: | 3302538293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 04/08/2010 | ||||||||
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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 | 34004773 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000032022 | 01 | OH | BC BS | OTHER | 0803661 | 05 | OH | MEDICAID | 930117529 | 01 | RR MCR | OTHER |