Healthcare Provider Details

I. General information

NPI: 1578599189
Provider Name (Legal Business Name): DIMITRIOS THOMAS PATRIANAKOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5683 N MILWAUKEE AVE
CHICAGO IL
60646-6220
US

IV. Provider business mailing address

5683 N MILWAUKEE AVE
CHICAGO IL
60646-6220
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-2020
  • Fax: 773-792-2025
Mailing address:
  • Phone: 773-792-2020
  • Fax: 773-792-2025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: