Provider Demographics
NPI:1194838045
Name:DIMITROPOULOS, VASSILIOS A (MD)
Entity Type:Individual
Prefix:
First Name:VASSILIOS
Middle Name:A
Last Name:DIMITROPOULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-4645
Mailing Address - Country:US
Mailing Address - Phone:630-920-1900
Mailing Address - Fax:630-920-1901
Practice Address - Street 1:10282 W 400 N
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9470
Practice Address - Country:US
Practice Address - Phone:773-351-2862
Practice Address - Fax:773-358-2767
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113849207N00000X, 207ND0101X, 207NS0135X
IN01084831A207N00000X
MI4301079801207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI27-0422873OtherST JOSEPH DERMATOLOGY TAX ID
IL813288715OtherUNIVERSITY DERMATOLOGY AND VEIN CLINIC
IL27-0907956OtherUNIVERSITY DERMATOLOGY TAX ID
MI813301692OtherST JOSEPH DERMATOLOGY AND VEIN CLINIC
MI1194838045Medicaid