Provider Demographics
NPI:1811080138
Name:POLIZOS, THEODORE (DPM)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:POLIZOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95727
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-0727
Mailing Address - Country:US
Mailing Address - Phone:773-271-9050
Mailing Address - Fax:773-271-9051
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3500
Practice Address - Country:US
Practice Address - Phone:773-271-9050
Practice Address - Fax:773-271-9051
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004322213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480028904OtherRRM
IL016004322Medicaid
IL01608070OtherBCBS
IL1312440001Medicare NSC
IL480028904OtherRRM
IL016004322Medicaid