Provider Demographics
NPI:1174585228
Name:SIDERIS, STYLIANOS (MD)
Entity type:Individual
Prefix:DR
First Name:STYLIANOS
Middle Name:
Last Name:SIDERIS
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:PO BOX 3989
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-3989
Mailing Address - Country:US
Mailing Address - Phone:956-854-4540
Mailing Address - Fax:956-854-4557
Practice Address - Street 1:2603 MICHAELANGELO DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-362-8767
Practice Address - Fax:956-362-2548
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2235208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176914301Medicaid
TXI45432Medicare UPIN