Healthcare Provider Details

I. General information

NPI: 1174918023
Provider Name (Legal Business Name): KATERINA MARIE BAKHOS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATERINA PORCARO M.D

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 WAUKEGAN RD STE 100
BANNOCKBURN IL
60015-1857
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-444-5300
  • Fax: 847-267-1429
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME151119
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036145965
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036145965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: