Provider Demographics
NPI:1902909138
Name:EVANGELIDIS, APOSTOLOS (MD)
Entity Type:Individual
Prefix:
First Name:APOSTOLOS
Middle Name:
Last Name:EVANGELIDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-9669
Mailing Address - Country:US
Mailing Address - Phone:785-537-8710
Mailing Address - Fax:785-537-0562
Practice Address - Street 1:1133 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2770
Practice Address - Country:US
Practice Address - Phone:785-537-8710
Practice Address - Fax:785-537-0532
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0430542208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200389640AMedicaid
KS0000105720OtherBLUE CROSS BLUE SHIELD
KS016261Medicare PIN