Provider Demographics
NPI:1780223115
Name:DANDINIDIS, DIMITRIOS (MOT/L)
Entity Type:Individual
Prefix:
First Name:DIMITRIOS
Middle Name:
Last Name:DANDINIDIS
Suffix:
Gender:M
Credentials:MOT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 E 93RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3909
Mailing Address - Country:US
Mailing Address - Phone:773-967-5221
Mailing Address - Fax:773-967-5972
Practice Address - Street 1:10110 IVANHOE AVE
Practice Address - Street 2:
Practice Address - City:SCHILLER PARK
Practice Address - State:IL
Practice Address - Zip Code:60176-2044
Practice Address - Country:US
Practice Address - Phone:708-407-8334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.007273225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist