Healthcare Provider Details

I. General information

NPI: 1578525507
Provider Name (Legal Business Name): YIANNIS LIMCAOCO KATSOGRIDAKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CHILDRENS PLAZA CHILDRENS MEMORIAL HOSPITAL
CHICAGO IL
60614-3394
US

IV. Provider business mailing address

2300 CHILDRENS PLAZA BOX 62 DIVISION OF PEDIATRIC EMERGENCY MEDICINE
CHICAGO IL
60614-3394
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-8245
  • Fax: 773-880-8267
Mailing address:
  • Phone: 773-880-4280
  • Fax: 773-880-8267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036109474
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number036109474
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: