Provider Demographics
NPI:1205014453
Name:KARAVIDAS, GERASIMOS
Entity Type:Individual
Prefix:
First Name:GERASIMOS
Middle Name:
Last Name:KARAVIDAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8615 CRAWFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2125
Mailing Address - Country:US
Mailing Address - Phone:630-776-1936
Mailing Address - Fax:
Practice Address - Street 1:8615 CRAWFORD AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2125
Practice Address - Country:US
Practice Address - Phone:630-776-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist