Provider Demographics
NPI:1356534721
Name:LIMPERIS, MAKIS G (MD)
Entity type:Individual
Prefix:
First Name:MAKIS
Middle Name:G
Last Name:LIMPERIS
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 1:1125 WESTGATE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1007
Mailing Address - Country:US
Mailing Address - Phone:708-848-0040
Mailing Address - Fax:708-848-2931
Practice Address - Street 1:1125 WESTGATE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1007
Practice Address - Country:US
Practice Address - Phone:708-848-0040
Practice Address - Fax:708-848-2931
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036076498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076498Medicaid
557950Medicare PIN
IL036076498Medicaid