Provider Demographics
NPI:1417141987
Name:GEORGE KOTSAKIS DMD LTD
Entity Type:Organization
Organization Name:GEORGE KOTSAKIS DMD LTD
Other - Org Name:ORAL & MAXILLOFACIAL SURGEON
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTSAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:847-884-7080
Mailing Address - Street 1:1585 N BARRINGTON RD
Mailing Address - Street 2:#506
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-5020
Mailing Address - Country:US
Mailing Address - Phone:847-884-7080
Mailing Address - Fax:847-884-8894
Practice Address - Street 1:1585 N BARRINGTON RD
Practice Address - Street 2:#506
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-5020
Practice Address - Country:US
Practice Address - Phone:847-884-7080
Practice Address - Fax:847-884-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
772591Medicare PIN
ILT38847Medicare UPIN