Provider Demographics
NPI:1447560214
Name:STAVROS O ALEXOPOULOS INC
Entity Type:Organization
Organization Name:STAVROS O ALEXOPOULOS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STAVROS
Authorized Official - Middle Name:ORESTIS
Authorized Official - Last Name:ALEXOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-561-8100
Mailing Address - Street 1:2740 W FOSTER AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3500
Mailing Address - Country:US
Mailing Address - Phone:773-561-8100
Mailing Address - Fax:
Practice Address - Street 1:2740 WEST FOSTER AVE.
Practice Address - Street 2:SUITE 107
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:773-561-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004298213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU37524Medicare UPIN
IL792730Medicare PIN