Provider Demographics
NPI:1114920824
Name:ASIMACOPOULOS, VOULA (MD)
Entity Type:Individual
Prefix:
First Name:VOULA
Middle Name:
Last Name:ASIMACOPOULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2120
Mailing Address - Country:US
Mailing Address - Phone:847-832-6500
Mailing Address - Fax:847-832-6040
Practice Address - Street 1:205 S NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-5802
Practice Address - Country:US
Practice Address - Phone:847-292-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083859Medicaid
ILF51439Medicare UPIN
IL036083859Medicaid