Provider Demographics
NPI:1083689137
Name:TSOUKAS, MARIA MAGDALENE (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MAGDALENE
Last Name:TSOUKAS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1847 N DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5002
Mailing Address - Country:US
Mailing Address - Phone:312-479-8649
Mailing Address - Fax:
Practice Address - Street 1:1801 W TAYLOR ST STE 3E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4795
Practice Address - Country:US
Practice Address - Phone:312-413-7448
Practice Address - Fax:312-996-1188
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223293207NS0135X
IL036114916207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology