Provider Demographics
NPI:1134110448
Name:PAPANOS, NICHOLAS S (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:S
Last Name:PAPANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7447 W. TALCOTT AVE
Mailing Address - Street 2:SUITE 512
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631
Mailing Address - Country:US
Mailing Address - Phone:773-774-1790
Mailing Address - Fax:773-774-1796
Practice Address - Street 1:1875 WEST DEMPSTER STREET
Practice Address - Street 2:SUITE 601
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068
Practice Address - Country:US
Practice Address - Phone:847-692-6750
Practice Address - Fax:847-692-6755
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036091974207R00000X
IL036-091974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036091974Medicaid
IL036-091974Medicaid
IL036091974Medicaid
IL036-091974Medicaid