Provider Demographics
NPI:1114958543
Name:LITSAS, VASILIOS (DPM)
Entity Type:Individual
Prefix:DR
First Name:VASILIOS
Middle Name:
Last Name:LITSAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 WILLOW SPRINGS RD
Mailing Address - Street 2:S.E. SUITE
Mailing Address - City:LA GRANGE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6145
Mailing Address - Country:US
Mailing Address - Phone:708-588-0250
Mailing Address - Fax:708-588-0256
Practice Address - Street 1:4705 WILLOW SPRINGS RD
Practice Address - Street 2:S.E. SUITE
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525-6145
Practice Address - Country:US
Practice Address - Phone:708-588-0250
Practice Address - Fax:708-588-0256
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005036213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU92147Medicare UPIN
ILIL2123Medicare PIN