Individual
JOHN STATHOPOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1620 W HARRISON ST, CHICAGO, IL 60612-3801
(312) 942-5000
Mailing address
1620 W HARRISON ST, CHICAGO, IL 60612-3801
(312) 942-5000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125082637
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2022
Last updated
07/27/2023
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