Provider Demographics
NPI:1043547565
Name:CHAKOS, DEREK
Entity Type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:CHAKOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 GLENWOOD DR APT 201
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:60108
Mailing Address - Country:US
Mailing Address - Phone:708-595-3086
Mailing Address - Fax:
Practice Address - Street 1:358 GLENWOOD DR APT 201
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:OH
Practice Address - Zip Code:60108
Practice Address - Country:US
Practice Address - Phone:708-595-3086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)