Individual
SPYRIDON P THEODORAKIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5011 N LINCOLN AVE, CHICAGO, IL 60625-2611
(773) 561-7710
(773) 561-7760
Mailing address
5011 N LINCOLN AVE, CHICAGO, IL 60625-2611
(773) 561-7710
(773) 561-7760
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036058530
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1617875
BLUE CROSS BLUE SHIELD
IL
05
—
36058530
—
IL
Enumeration date
08/10/2005
Last updated
10/18/2010
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