Healthcare Provider Details

I. General information

NPI: 1871617969
Provider Name (Legal Business Name): JAMES LOUIS BAKOS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 09/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6905 W. CERMAK ROAD
BERWYN IL
60402-2172
US

IV. Provider business mailing address

6905 W. CERMAK ROAD
BERWYN IL
60402-2172
US

V. Phone/Fax

Practice location:
  • Phone: 708-795-5552
  • Fax:
Mailing address:
  • Phone: 708-795-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016.003002
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number316000660
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: