Organization
PRO SPORTS & SPINE REHABILITATION, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN C SARANTOPOULOS DO (OFFICER)
(630) 924-1450
Entity
Organization
Contact information
Practice address
6374 N LINCOLN AVE, SUITE 301, CHICAGO, IL 60659-1275
(630) 924-1450
(630) 924-1459
Mailing address
6374 N LINCOLN AVE, SUITE 301, CHICAGO, IL 60659-1275
(630) 924-1450
(630) 924-1459
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036094371
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01638376
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/26/2007
Last updated
05/22/2008
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