Provider Demographics
NPI:1275729287
Name:H DEMITRI MEDICAL SC
Entity Type:Organization
Organization Name:H DEMITRI MEDICAL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HARALAMBOS
Authorized Official - Middle Name:
Authorized Official - Last Name:HATZIDIMITRIADIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-658-2300
Mailing Address - Street 1:3960 N HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2219
Mailing Address - Country:US
Mailing Address - Phone:773-658-2300
Mailing Address - Fax:773-658-2305
Practice Address - Street 1:33 N ADDISON RD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-3875
Practice Address - Country:US
Practice Address - Phone:630-530-4144
Practice Address - Fax:630-530-7404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01634343OtherBLUE CROSS BLUE SHIELD PI
IL209249Medicare PIN