Provider Demographics
NPI:1639185275
Name:SARANTOPOULOS, JOHN C (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:SARANTOPOULOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:490 WEST LAKE STREET
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3500
Mailing Address - Country:US
Mailing Address - Phone:630-924-1450
Mailing Address - Fax:630-924-1459
Practice Address - Street 1:490 WEST LAKE STREET
Practice Address - Street 2:SUITE 105
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3500
Practice Address - Country:US
Practice Address - Phone:630-924-1450
Practice Address - Fax:630-924-1459
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036094371208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364374397OtherTAX ID
IL6206500001OtherMEDICARE DME NUMBER
IL6206500001OtherMEDICARE DME NUMBER
IL208593Medicare ID - Type UnspecifiedDUPAGE
IL208596Medicare ID - Type UnspecifiedCOOK