Healthcare Provider Details

I. General information

NPI: 1407093537
Provider Name (Legal Business Name): GEORGIOS NIKOLAOS ASIMIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W RANDOLPH ST STE 202-B
CHICAGO IL
60607-2336
US

IV. Provider business mailing address

805 W RANDOLPH ST STE 202-B
CHICAGO IL
60607-2336
US

V. Phone/Fax

Practice location:
  • Phone: 312-526-3500
  • Fax: 312-291-9126
Mailing address:
  • Phone: 312-526-3500
  • Fax: 312-291-9126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number830158
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number036135927
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036135927
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number036135927
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036135927
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: