Provider Demographics
NPI:1255366191
Name:SIANIS, GEORGE (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SIANIS
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 1:6374 N LINCOLN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1275
Mailing Address - Country:US
Mailing Address - Phone:773-478-5600
Mailing Address - Fax:773-478-5602
Practice Address - Street 1:4921 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1921
Practice Address - Country:US
Practice Address - Phone:773-478-5600
Practice Address - Fax:773-478-5602
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-063761207RG0300X, 208600000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063761Medicaid
IL01635073OtherBCBS
ILP00390786OtherRAILROAD MEDICARE
ILC45864Medicare UPIN
IL036063761Medicaid