Provider Demographics
NPI:1447694153
Name:MIKELIS, DEMETRIOS (MD)
Entity type:Individual
Prefix:
First Name:DEMETRIOS
Middle Name:
Last Name:MIKELIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CHASE RD
Mailing Address - Street 2:PO BOX 701
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-7500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE 170 WEST
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2061
Practice Address - Country:US
Practice Address - Phone:516-355-0111
Practice Address - Fax:516-355-5011
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216578207R00000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine