Provider Demographics
NPI:1952497729
Name:DALLAS, NIKOLAOS ANDREAS (MD)
Entity Type:Individual
Prefix:
First Name:NIKOLAOS
Middle Name:ANDREAS
Last Name:DALLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5194
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:3000 N HALSTED ST STE 509
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5194
Practice Address - Country:US
Practice Address - Phone:773-296-3390
Practice Address - Fax:773-296-7531
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036119424208600000X
TXM5118208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192628902 (MDACC)Medicaid
TX8CV491 (MDACC)OtherBCBS
FL8V4806OtherBCBS
FL8V4806OtherBCBS
TXTXB127097 (MDACC)Medicare PIN