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NPI Code Detail

MEDICARE: DR. HARALAMBOS HATZIDIMITRIADIS MD

MEDICARE: DR. HARALAMBOS HATZIDIMITRIADIS 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
1207R00000XInternal Medicine Physician036069054IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
201634343OTHERILBLUE CROSS BLUE SHIELD PI

General Provider Information

NPI Number : 1780766170
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HARALAMBOS HATZIDIMITRIADIS MD
Provider Business Mailing Address
First Line : 3960 N HARLEM AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2219
Country : US
Telephone Number : 773-658-2300
Fax Number : 773-658-2305
Provider Business Practice Location Address
First Line : 3960 N HARLEM AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60634-2219
Country : US
Telephone Number : 773-658-2300
Fax Number : 773-658-2305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2006
Last Update Date : 01/21/2008

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