Provider Demographics
NPI:1588617757
Name:VLAHOS, ATHANASIOS (MD)
Entity Type:Individual
Prefix:
First Name:ATHANASIOS
Middle Name:
Last Name:VLAHOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N ELM ST
Mailing Address - Street 2:STE 128
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3634
Mailing Address - Country:US
Mailing Address - Phone:630-312-7865
Mailing Address - Fax:630-312-7902
Practice Address - Street 1:911 N ELM ST
Practice Address - Street 2:STE 128
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3634
Practice Address - Country:US
Practice Address - Phone:630-856-7460
Practice Address - Fax:630-655-9943
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361101552085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL158617757OtherGROUP NPI
ILDA1490OtherRRMC
IL399690Medicare PIN
IL208342Medicare PIN
ILK30159Medicare PIN
IL158617757OtherGROUP NPI
ILDA1490OtherRRMC
I36369Medicare UPIN