Provider Demographics
NPI:1629200498
Name:KARVELAS, KRISTOPHER ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:ROBERT
Last Name:KARVELAS
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 1:1030 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5467
Mailing Address - Country:US
Mailing Address - Phone:312-238-7767
Mailing Address - Fax:312-238-7709
Practice Address - Street 1:1030 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5467
Practice Address - Country:US
Practice Address - Phone:312-238-7767
Practice Address - Fax:312-238-7709
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-133416208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400101129Medicare PIN
ILF400101128Medicare PIN