Healthcare Provider Details

I. General information

NPI: 1548517949
Provider Name (Legal Business Name): MICHAEL SIDIROPOULOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 1600
CHICAGO IL
60611-2997
US

IV. Provider business mailing address

600 N MCCLURG CT APT 4406A
CHICAGO IL
60611-4854
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7932
  • Fax:
Mailing address:
  • Phone: 416-274-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number125060741
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: