Healthcare Provider Details

I. General information

NPI: 1356205348
Provider Name (Legal Business Name): ALEXANDRA ALEXOPOULOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27135 W WILMOT RD
ANTIOCH IL
60002-9165
US

IV. Provider business mailing address

49 MJ LN APT 2
DE SOTO IL
62924-3561
US

V. Phone/Fax

Practice location:
  • Phone: 224-603-2058
  • Fax: 217-236-0801
Mailing address:
  • Phone: 847-703-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: