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NPI Code Detail

MEDICARE: DR. EMMANUEL LOUTRIANAKIS MD

MEDICARE: DR. EMMANUEL LOUTRIANAKIS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician036100357IL
2207RI0011XInterventional Cardiology Physician036100357IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013974187
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EMMANUEL LOUTRIANAKIS MD
Provider Business Mailing Address
First Line : 1 GOOD SAMARITAN WAY
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-2402
Country : US
Telephone Number : 847-736-0506
Fax Number :
Provider Business Practice Location Address
First Line : 1 GOOD SAMARITAN WAY
Second Line :
City : MOUNT VERNON
State : IL
Zip : 62864-2402
Country : US
Telephone Number : 847-736-0506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2006
Last Update Date : 08/15/2023

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