Provider Demographics
NPI:1609261064
Name:SACLARIDES, CONSTANTINE PETER
Entity Type:Individual
Prefix:
First Name:CONSTANTINE
Middle Name:PETER
Last Name:SACLARIDES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:EMS BLDG 110- ROOM 32
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:708-327-3436
Mailing Address - Fax:708-327-3489
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:EMS BLDG 110- ROOM 3210
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-327-3436
Practice Address - Fax:708-327-3489
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125066973208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery