Healthcare Provider Details

I. General information

NPI: 1013995232
Provider Name (Legal Business Name): IRENE M BAKOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 W NORTH AVE
ELMWOOD PARK IL
60707-4116
US

IV. Provider business mailing address

7740 W NORTH AVE
ELMWOOD PARK IL
60707-4116
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-0500
  • Fax: 708-450-1070
Mailing address:
  • Phone: 708-450-0500
  • Fax: 708-450-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036062531
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: