MEDICARE: DR. GREGORY MICHAEL PAPPAS OD

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
1	152W00000X	Optometrist	046011468	IL

General Provider Information

NPI Number	:	1386250884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY MICHAEL PAPPAS OD

Provider Business Mailing Address
First Line	:	1444 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-4827
Country	:	US
Telephone Number	:	312-588-5999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1444 S MICHIGAN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-4827
Country	:	US
Telephone Number	:	312-588-5999
Fax Number	:	312-588-0599

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2020
Last Update Date	:	09/20/2020

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