Provider Demographics
NPI:1114025574
Name:KARAKOURTIS, MICHAEL JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOHN
Last Name:KARAKOURTIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 S BROM DRIVE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6595
Mailing Address - Country:US
Mailing Address - Phone:630-355-9449
Mailing Address - Fax:630-355-5073
Practice Address - Street 1:720 S BROM DRIVE
Practice Address - Street 2:SUITE #103
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6595
Practice Address - Country:US
Practice Address - Phone:630-355-9449
Practice Address - Fax:630-355-5073
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T36216Medicare UPIN
IL308240Medicare ID - Type Unspecified