Individual
DEMETRIOS KATSAROS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7863 BROADWAY, SUITE 135, MERRILLVILLE, IN 46410-5553
(219) 736-2047
(219) 736-2048
Mailing address
4503 THORNBURY DR E, VALPARAISO, IN 46383-0813
(219) 549-0837
(219) 548-0857
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01049411
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000080178
BLUE CROSS BLUE SHIELD
IN
05
—
200195840B
—
IN
Enumeration date
02/27/2007
Last updated
07/08/2007
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