Organization
ASKLEPIOS MEDICAL GROUP LTD
Active
Organization
ASKLEPIOS MEDICAL GROUP LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOTERIOS G POLYCHRONOPOULOS MD (OWNER OF MEDICAL GROUP PRACTICE)
(773) 445-2422
Entity
Organization
Contact information
Practice address
11638 S WESTERN AVE, CHICAGO, IL 60643-4730
(773) 445-2422
(773) 445-5182
Mailing address
11638 S WESTERN AVE, CHICAGO, IL 60643-4730
(773) 445-2422
(773) 445-5182
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036051757
—
IL
01
—
110019213
RAILROAD
IL
01
—
31602250
BCBS
IL
Enumeration date
08/16/2005
Last updated
07/09/2010
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