Provider Demographics
NPI:1609832518
Name:PAPAKOSTAS, ANDREAS (LATC, LMT)
Entity Type:Individual
Prefix:MR
First Name:ANDREAS
Middle Name:
Last Name:PAPAKOSTAS
Suffix:
Gender:M
Credentials:LATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14703 PAUL REVERE
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544
Mailing Address - Country:US
Mailing Address - Phone:815-439-9170
Mailing Address - Fax:
Practice Address - Street 1:24402 W. LOCKPORT STREET
Practice Address - Street 2:SUITE 2F
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544
Practice Address - Country:US
Practice Address - Phone:815-439-2303
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist