Michael Stephan Xydakis, MD, MSC

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

036094516 Issued in IL

Practice address

88TH Medical Group
4881 Sugar Maple Drive, BLDG 830
Wright Patterson AFB, OH 45433-5529

Phone

(937) 656-5434

NPI assigned

May 24, 2006

Last updated

Jul 22, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563753600000",
    "number": "1629023759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "88TH MEDICAL GROUP",
            "address_2": "4881 SUGAR MAPLE DRIVE, BLDG 830",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "88TH MEDICAL GROUP",
            "address_2": "4881 SUGAR MAPLE DRIVE, BLDG 830",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-656-5434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "XYDAKIS",
        "first_name": "MICHAEL",
        "middle_name": "STEPHAN",
        "name_prefix": "Dr.",
        "credential": "MD, MSC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-24",
        "last_updated": "2019-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "IL",
            "license": "036094516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "AHLTA",
            "affiliation": "N",
            "address_1": "88th Medical Group",
            "address_2": "4881 Sugar Maple Drive, Bldg 830",
            "city": "Wright Patterson AFB",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454335529",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Joe Dunham Wood III, PSYD
• Richard Wood, D.O.
• Robert A Wootton, PHARMD
• Wright Patterson Medical Center
• Steve Thomas Wright, OD, MS
• Adam N Young, DO
• Ilene Young
• Jaaron Alexander Zentz
• Jessica Erin Zhen, MD
• An Zhu, MD

• Otolaryngology Physician in Wright Patterson AFB, OH
• Providers in Wright Patterson AFB, OH by specialty
• Otolaryngology Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.