Individual
DEMETRIUS MARCOULIDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4417 W DIVERSEY AVE, CHICAGO, IL 60639-1923
(815) 642-5723
Mailing address
PO BOX 746715, ATLANTA, GA 30374-6715
(773) 352-1515
(312) 929-0373
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
209022856
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
277.005052
IL
Other
Enumeration date
07/12/2018
Last updated
01/13/2026
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