Individual
STATHIS POULAKIDAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 S MILWAUKEE AVE, LIBERTYVILLE, IL 60048-3204
(847) 362-2900
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036-099012
IL
2086S0102X
Surgical Critical Care Physician
Primary
36099012
IL
2086S0127X
Trauma Surgery Physician
36099012
IL
Other
Enumeration date
03/01/2006
Last updated
04/07/2022
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