Provider Demographics
NPI:1417069022
Name:ANGELOPOULOS, MARY (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ANGELOPOULOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 W FRONTAGE RD STE 2745
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1260
Mailing Address - Country:US
Mailing Address - Phone:847-716-1302
Mailing Address - Fax:847-716-1312
Practice Address - Street 1:550 W FRONTAGE RD STE 2745
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-1260
Practice Address - Country:US
Practice Address - Phone:847-716-1302
Practice Address - Fax:847-716-1312
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0883822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036088382Medicaid
IL1630244OtherBCBS
IL1630244OtherBCBS
ILG25051Medicare UPIN