Provider Demographics
NPI:1982756292
Name:SPIROPOULOS, SPIRO (DN)
Entity Type:Individual
Prefix:
First Name:SPIRO
Middle Name:
Last Name:SPIROPOULOS
Suffix:
Gender:M
Credentials:DN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-2271
Mailing Address - Country:US
Mailing Address - Phone:184-751-6388
Mailing Address - Fax:
Practice Address - Street 1:1510 W ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60067-4771
Practice Address - Country:US
Practice Address - Phone:184-722-1579
Practice Address - Fax:847-221-5822
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01633785OtherBC BS GRP #