Provider Demographics
NPI:1710102017
Name:ALEXOPOULOS, STAVROS ORESTIS (DPM)
Entity Type:Individual
Prefix:
First Name:STAVROS
Middle Name:ORESTIS
Last Name:ALEXOPOULOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3543
Mailing Address - Country:US
Mailing Address - Phone:773-561-8100
Mailing Address - Fax:
Practice Address - Street 1:2740 W FOSTER AVE STE 107
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3543
Practice Address - Country:US
Practice Address - Phone:773-561-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004298213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60010812OtherBLUE SHIELD OF ILLINOIS
U37524Medicare UPIN
792730Medicare ID - Type Unspecified