Provider Demographics
NPI:1508820184
Name:MARAGOS, STAVROS G (MD)
Entity Type:Individual
Prefix:DR
First Name:STAVROS
Middle Name:G
Last Name:MARAGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:195 SPRINGFIELD AVE UNIT 201
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6526
Practice Address - Country:US
Practice Address - Phone:815-823-8200
Practice Address - Fax:815-823-8201
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097947207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097947Medicaid
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL060049939OtherCOOK COUNTY RAILRAOD MEDI
IL060056569OtherKANKAKEE RAILROAD MEDICAR
IL01621208OtherBLUECROSSBLUESHIELD
IL416810OtherMEDICARE GROUP
IL236550OtherMEDICARE GROUP
IL236551OtherMEDICARE GROUP
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL060049938OtherWILL COUNTY RAILROAD MEDI
IL1508810086OtherGROUP NPI
IL792811OtherUNITED HMO PROVIDER NUMBE
IL060049939OtherCOOK COUNTY RAILRAOD MEDI
IL236550OtherMEDICARE GROUP
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER