Provider Demographics
NPI:1235441023
Name:MIHAILIDIS, DEMYTRA KRISTA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:DEMYTRA
Middle Name:KRISTA LEE
Last Name:MIHAILIDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEMYTRA
Other - Middle Name:KRISTA LEE
Other - Last Name:MITSIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3 NEENAH CTR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:920-364-3600
Mailing Address - Fax:920-364-3900
Practice Address - Street 1:2500 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-8735
Practice Address - Country:US
Practice Address - Phone:920-364-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310018207RH0003X, 207RX0202X
WI84135207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology