Provider Demographics
NPI:1649283516
Name:POLIMENAKOS, ANASTASIOS C (MD)
Entity type:Individual
Prefix:
First Name:ANASTASIOS
Middle Name:C
Last Name:POLIMENAKOS
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 1:3820 NORTHDALE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1893
Mailing Address - Country:US
Mailing Address - Phone:813-961-1331
Mailing Address - Fax:
Practice Address - Street 1:1640 N ARLINGTON HEIGHTS RD STE 201
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3985
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0712712080P0202X, 208G00000X
IL036.120154208600000X
MDD0101444208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA071271OtherGA LICENSES
GA071271OtherGA LICENSES