1114025574 NPI number — DR. MICHAEL JOHN KARAKOURTIS DDS

Table of content: DR. MICHAEL JOHN KARAKOURTIS DDS (NPI 1114025574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114025574 NPI number — DR. MICHAEL JOHN KARAKOURTIS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KARAKOURTIS
Provider First Name:
MICHAEL
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1114025574
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 S BROM DRIVE
Provider Second Line Business Mailing Address:
SUITE #103
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60540-6595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-355-9449
Provider Business Mailing Address Fax Number:
630-355-5073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 S BROM DRIVE
Provider Second Line Business Practice Location Address:
SUITE #103
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60540-6595
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-355-9449
Provider Business Practice Location Address Fax Number:
630-355-5073
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 204E00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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