Healthcare Provider Details

I. General information

NPI: 1770162521
Provider Name (Legal Business Name): EMELIA M. KARKAZIS DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 07/16/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 HOWARD ST STE 201
EVANSTON IL
60202-3877
US

IV. Provider business mailing address

801 S PAULINA ST
CHICAGO IL
60612-7210
US

V. Phone/Fax

Practice location:
  • Phone: 847-491-0660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019.033189
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number021.003337
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: