Provider Demographics
NPI:1720054950
Name:ASSIMACOPOULOS, ARISTIDES PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ARISTIDES
Middle Name:PAUL
Last Name:ASSIMACOPOULOS
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 1:901 MCCLINTOCK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0872
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:630-654-1865
Practice Address - Street 1:2460 CURTIS ELLIS DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2237
Practice Address - Country:US
Practice Address - Phone:252-962-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133426207R00000X
NC2023-00338207RI0200X
AZ45650207RI0200X
IL036-133426207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8005636Medicaid
MN55G66ASOtherBCBS
IA09739OtherBCBS
MN406083100Medicaid
AZ667295Medicaid
AR150576001Medicaid
AZP01180015OtherRAILROAD MEDICARE
ILF400212615Medicare UPIN
IA09739OtherBCBS
MN406083100Medicaid
AR150576001Medicaid
IL347710034Medicare PIN
IL347713029Medicare PIN
CA8005636Medicaid