Provider Demographics
NPI:1073530929
Name:PATRIANAKOS, THOMAS D (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:PATRIANAKOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5683 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-6220
Mailing Address - Country:US
Mailing Address - Phone:773-792-2020
Mailing Address - Fax:773-792-2025
Practice Address - Street 1:5683 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6220
Practice Address - Country:US
Practice Address - Phone:773-792-2020
Practice Address - Fax:773-792-2025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-113316207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001637629OtherBLUE CROSS BLUE SHIELD
IL036113316Medicaid
ILI55703Medicare UPIN