Healthcare Provider Details

I. General information

NPI: 1902070691
Provider Name (Legal Business Name): DR. CHARILAOS PAPAFRAGKAKIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 W WELLINGTON AVE INTERNAL MEDICINE DEPARTMENT
CHICAGO IL
60657
US

IV. Provider business mailing address

856 W NELSON ST APT#1803
CHICAGO IL
60657-5152
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7635
  • Fax:
Mailing address:
  • Phone: 773-329-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number036118241
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: