Theodorakis, Spyridon P

Theodorakis, Spyridon P is an individual health care provider with primary practice located at 5011 N Lincoln Ave , Chicago IL 60625-2611. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Theodorakis, Spyridon P can be contacted via phone (773) 561-7710.

Contact Information

Primary practice address
5011 N Lincoln Ave Chicago IL 60625-2611
Phone: (773) 561-7710
Fax: (773) 561-7760
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Surgery 208600000X 036058530 Illinois

Profile Details

NPI number 1922009059
LBN Legal business name Theodorakis, Spyridon P
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 10th, 2005
Last updated Oct 18th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1922009059 NPPES
Illinois Other 1617875 BLUE CROSS BLUE SHIELD
Illinois MEDICAID 36058530 BLUE CROSS BLUE SHIELD

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