Provider Demographics
NPI:1740231596
Name:CHRISTOPOULOS, REGAN ALENE (MD)
Entity Type:Individual
Prefix:DR
First Name:REGAN
Middle Name:ALENE
Last Name:CHRISTOPOULOS
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Gender:F
Credentials:MD
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Mailing Address - Street 1:731 S ILLINOIS ROUTE 21
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3813
Mailing Address - Country:US
Mailing Address - Phone:847-566-3337
Mailing Address - Fax:847-816-3166
Practice Address - Street 1:DEERPATH PHYSICIANS GROUP
Practice Address - Street 2:731 S ILLINOIS ROUTE 21
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3813
Practice Address - Country:US
Practice Address - Phone:847-566-3337
Practice Address - Fax:847-816-3166
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2021-02-16
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Provider Licenses
StateLicense IDTaxonomies
IL036-107767207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04930281OtherBLUE CROSS BLUE SHIELD
ILH89676Medicare UPIN
IL916950Medicare PIN