Individual
JOHN IKONOMIDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
221 W. COLORADO BLVD., PAVILION II SUITE 728, DALLAS, TX 75208
(469) 695-2055
(469) 695-2056
Mailing address
221 W. COLORADO BLVD., PAVILION II SUITE 728, DALLAS, TX 75208
(469) 695-2055
(469) 695-2056
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
22034
SC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
W0185
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T61304
—
SC
Enumeration date
08/20/2006
Last updated
09/03/2025
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