Provider Demographics
NPI:1770536187
Name:NIKOLAIDIS, FRANK (DO)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:NIKOLAIDIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 74994
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-1077
Mailing Address - Country:US
Mailing Address - Phone:614-430-5724
Mailing Address - Fax:
Practice Address - Street 1:400 AUSTIN AVE NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-3554
Practice Address - Country:US
Practice Address - Phone:330-837-7200
Practice Address - Fax:330-837-7572
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006497207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00091935OtherMEDICARE RAILROAD
OH0351711Medicaid
000000328570OtherANTHEM
000000328570OtherANTHEM
OH0351711Medicaid