Provider Demographics
NPI:1457402919
Name:KARDASIS, CHRISTOPHER THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:THEODORE
Last Name:KARDASIS
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 1:17850 KEDZIE AVE
Mailing Address - Street 2:DOCTORS PAVILION SUITE 1200
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2058
Mailing Address - Country:US
Mailing Address - Phone:708-799-3720
Mailing Address - Fax:708-799-3733
Practice Address - Street 1:17850 KEDZIE AVE
Practice Address - Street 2:DOCTORS PAVILION SUITE 1200
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2058
Practice Address - Country:US
Practice Address - Phone:708-799-3720
Practice Address - Fax:708-799-3733
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096219207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096219Medicaid
IL180043027OtherRR MEDICARE PROVIDER NO.
IL01620286OtherBCBS PROVIDER NUMBER
IL30022730030338OtherADVOCATE PROVIDER NUMBER
IL30022730030338OtherADVOCATE PROVIDER NUMBER
IL036096219Medicaid