Individual
NICKOLAS KATSOULAKIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7340 W COLLEGE DR, 2ND FLOOR, PALOS HEIGHTS, IL 60463-1159
(708) 361-7800
(708) 361-8737
Mailing address
7340 W COLLEGE DR, 2ND FLOOR, PALOS HEIGHTS, IL 60463-1159
(708) 361-7800
(708) 361-8737
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036123759
IL
207W00000X
Ophthalmology Physician
247724
NY
207W00000X
Ophthalmology Physician
LP00389
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
650A31
EMPIRE BLUE CROSS BLUE SHIELD
NY
01
—
P00673435
PALMETTO
NY
Enumeration date
04/19/2007
Last updated
02/18/2010
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