Individual
DOROTHEA POULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
87 N AIRLITE ST STE 130, ELGIN, IL 60123-4991
(847) 888-3661
(847) 888-9964
Mailing address
87 N AIRLITE ST STE 130, ELGIN, IL 60123-4991
(847) 888-3661
(847) 888-9964
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-066780
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036066780
—
IL
01
—
110021524
RAILROAD RETIREMENT BOARD
—
Enumeration date
10/10/2005
Last updated
12/03/2021
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