Healthcare Provider Details

I. General information

NPI: 1639117344
Provider Name (Legal Business Name): ANTHONY D PAPADATOS MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N LAKE SHORE DR APT 6101
CHICAGO IL
60611-3429
US

IV. Provider business mailing address

505 N LAKE SHORE DR APT 6101
CHICAGO IL
60611-3429
US

V. Phone/Fax

Practice location:
  • Phone: 312-828-9552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number01059771A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.112284
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: