Basic Information
| Provider Information | |||||||||
| NPI: | 1104877828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FILIADIS | ||||||||
| FirstName: | GEORGIOS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | SUITE 130- PROVIDER ENROLLMENT | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306565911 | ||||||||
| FaxNumber: | 3179624343 | ||||||||
| Practice Location | |||||||||
| Address1: | 476 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ANDOVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440039602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308414000 | ||||||||
| FaxNumber: | 3306565901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 02/07/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 34008624 | OH | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 02004003A | IN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | OH | MEDICAID |