Provider Demographics
NPI:1720169758
Name:ECONOMOS, DEAN SPIROS (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:SPIROS
Last Name:ECONOMOS
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 1:727 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-9748
Mailing Address - Country:US
Mailing Address - Phone:847-973-9640
Mailing Address - Fax:847-973-9639
Practice Address - Street 1:727 GRAND AVE
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041-9748
Practice Address - Country:US
Practice Address - Phone:847-973-9640
Practice Address - Fax:847-973-9639
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099612207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG94838Medicare UPIN
IL545380Medicare ID - Type Unspecified