Provider Demographics
NPI:1952330243
Name:KONSTANTELOS, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:KONSTANTELOS
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 1:5212 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640
Mailing Address - Country:US
Mailing Address - Phone:773-500-0246
Mailing Address - Fax:773-825-8299
Practice Address - Street 1:5212 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-500-0246
Practice Address - Fax:773-825-8299
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I00535Medicare UPIN