Healthcare Provider Details

I. General information

NPI: 1467436808
Provider Name (Legal Business Name): GEORGE TSATSOS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 W. BELMONT
CHICAGO IL
60618
US

IV. Provider business mailing address

2220 W. BELMONT
CHICAGO IL
60618
US

V. Phone/Fax

Practice location:
  • Phone: 773-348-7500
  • Fax: 630-203-1640
Mailing address:
  • Phone: 773-348-7500
  • Fax: 630-203-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number016003058
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number016003058
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016003058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: