Individual
LEONIDAS G KONIARIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD, INDIANAPOLIS, IN 46202-5149
(317) 278-7778
(317) 274-0241
Mailing address
250 N SHADELAND AVE, SUITE 130, PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(317) 963-0860
(317) 962-4343
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01072696A
IN
2086X0206X
Surgical Oncology Physician
MD442981
PA
2086X0206X
Surgical Oncology Physician
ME87729
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201208380
—
IN
05
—
2678489-00
—
FL
Enumeration date
04/17/2006
Last updated
01/13/2021
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