Provider Demographics
NPI:1821087669
Name:POULOS, DENISE M (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:M
Last Name:POULOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5851 W 95TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2362
Mailing Address - Country:US
Mailing Address - Phone:708-499-9800
Mailing Address - Fax:708-499-6203
Practice Address - Street 1:5851 W 95TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2362
Practice Address - Country:US
Practice Address - Phone:708-499-9800
Practice Address - Fax:708-499-6203
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036081009207VG0400X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6503001Medicare PIN
ILF32833Medicare UPIN
ILIL6502001Medicare PIN