1609174259 NPI number — ALEKSANDER KERZEE-STAMATELOPOULOS DPT

Table of content: ALEKSANDER KERZEE-STAMATELOPOULOS DPT (NPI 1609174259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609174259 NPI number — ALEKSANDER KERZEE-STAMATELOPOULOS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KERZEE-STAMATELOPOULOS
Provider First Name:
ALEKSANDER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1609174259
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 S GARY AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGDALE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60108-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-933-4550
Provider Business Mailing Address Fax Number:
630-933-2200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 S GARY AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMINGDALE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60108-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-933-4550
Provider Business Practice Location Address Fax Number:
630-933-2200
Provider Enumeration Date:
03/07/2011

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: 225100000X , with the licence number:  ID-2804 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 070018842 , 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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