Provider Demographics
NPI:1841409232
Name:NACOPOULOS, CONNIE
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:NACOPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:424 N BROADVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-1563
Mailing Address - Country:US
Mailing Address - Phone:630-247-3083
Mailing Address - Fax:
Practice Address - Street 1:424 N BROADVIEW AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-1563
Practice Address - Country:US
Practice Address - Phone:630-247-3083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-049354207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine