Provider Demographics
NPI:1699038885
Name:PAPAGIANNOPOULOS, DIMITRI (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMITRI
Middle Name:
Last Name:PAPAGIANNOPOULOS
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 1:610 E ROOSEVELT RD STE 203
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5581
Mailing Address - Country:US
Mailing Address - Phone:630-653-5550
Mailing Address - Fax:630-653-5561
Practice Address - Street 1:610 E ROOSEVELT RD STE 203
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187
Practice Address - Country:US
Practice Address - Phone:630-653-5550
Practice Address - Fax:630-653-5561
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146612208800000X
CAA147832208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology