Individual
GEORGE JASON ANTONOPOULOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
40 75TH ST, WILLOWBROOK, IL 60527-2325
(561) 734-9003
Mailing address
9101 ROBIN CT, ORLAND HILLS, IL 60487-4694
(708) 692-0240
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.021305
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209.021305
—
IL
Enumeration date
05/16/2020
Last updated
09/11/2023
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