1538231782 NPI number — THEODORE POLIZOS DPM COMPREHENSIVE PODIATRIC MEDICAL SERVICES, LTD.

Table of content: (NPI 1538231782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538231782 NPI number — THEODORE POLIZOS DPM COMPREHENSIVE PODIATRIC MEDICAL SERVICES, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THEODORE POLIZOS DPM COMPREHENSIVE PODIATRIC MEDICAL SERVICES, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPREHENSIVE PODIATRIC MEDICAL SERVICES, LTD.
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538231782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95727
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60195-0727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-271-9050
Provider Business Mailing Address Fax Number:
773-271-9051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2740 W FOSTER AVE
Provider Second Line Business Practice Location Address:
SUITE #205
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60625-3500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-271-9050
Provider Business Practice Location Address Fax Number:
773-271-9051
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
POLIZOS
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
773-271-9050

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01608070 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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