Provider Demographics
NPI:1336198357
Name:GIANNOULIAS, CHRISTOS S (MD/MS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOS
Middle Name:S
Last Name:GIANNOULIAS
Suffix:
Gender:M
Credentials:MD/MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S YORK RD
Mailing Address - Street 2:SUITE 4190
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5626
Mailing Address - Country:US
Mailing Address - Phone:630-782-1174
Mailing Address - Fax:
Practice Address - Street 1:1200 S YORK RD
Practice Address - Street 2:SUITE 4190
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5626
Practice Address - Country:US
Practice Address - Phone:630-782-1174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104649207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232584OtherBLUE CROSS BLUE SHIELD
IL036104649Medicaid
IL610189800OtherDEPT OF LABOR
ILP00192973OtherRAILROAD MEDICARE
ILH87818Medicare UPIN
ILK12546Medicare PIN