Individual
DR. AKILIS MIKE THEOHARIDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M
Contact information
Practice address
407 NE 76TH TER, GLADSTONE, MO 64118-1708
(816) 436-7900
(816) 436-0999
Mailing address
407 NE 76TH TER, GLADSTONE, MO 64118-1708
(816) 436-7900
(816) 436-0999
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
000747
MO
213ES0131X
Foot Surgery Podiatrist
Primary
000747
MO
213ES0131X
Foot Surgery Podiatrist
12-00294
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23501026
BLUE KC
—
05
—
308471408
—
MO
05
—
308471432
—
MO
01
—
480031697
RAILROAD GLADSTONE
—
01
—
480031700
RAILROAD AHN
—
Enumeration date
06/24/2006
Last updated
12/23/2020
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