Provider Demographics
NPI:1578525507
Name:KATSOGRIDAKIS, YIANNIS LIMCAOCO (MD)
Entity Type:Individual
Prefix:
First Name:YIANNIS
Middle Name:LIMCAOCO
Last Name:KATSOGRIDAKIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2300 CHILDRENS PLAZA
Mailing Address - Street 2:BOX 62 DIVISION OF PEDIATRIC EMERGENCY MEDICINE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3394
Mailing Address - Country:US
Mailing Address - Phone:773-880-4280
Mailing Address - Fax:773-880-8267
Practice Address - Street 1:2300 CHILDRENS PLAZA
Practice Address - Street 2:CHILDRENS MEMORIAL HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3394
Practice Address - Country:US
Practice Address - Phone:773-880-8245
Practice Address - Fax:773-880-8267
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2021-03-08
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Provider Licenses
StateLicense IDTaxonomies
IL036109474208000000X, 207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109474Medicaid