Provider Demographics
NPI:1073009874
Name:MENTZELOPOULOS, LILLIAN
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:
Last Name:MENTZELOPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:YOUKHANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 WINFIELD RD FL 3
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1200 S YORK ST STE 2000
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5634
Practice Address - Country:US
Practice Address - Phone:331-221-9004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005929213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist