Provider Demographics
NPI:1245303361
Name:STAMELOS CLINIC FOR ORTHOPEDIC DISORDERS INC
Entity type:Organization
Organization Name:STAMELOS CLINIC FOR ORTHOPEDIC DISORDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOPEDIC SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SPIROS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:STAMELOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-281-6700
Mailing Address - Street 1:1224 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3207
Mailing Address - Country:US
Mailing Address - Phone:773-281-6700
Mailing Address - Fax:847-632-1530
Practice Address - Street 1:1224 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3207
Practice Address - Country:US
Practice Address - Phone:773-281-6700
Practice Address - Fax:847-632-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31600815OtherBLUE CROSS BLUE SHIELD
IL31600815OtherBLUE CROSS BLUE SHIELD
IL=========OtherTAX ID
IL0917000001Medicare NSC
IL31600815OtherBLUE CROSS BLUE SHIELD
IL365310Medicare ID - Type UnspecifiedMEDICARE