Healthcare Provider Details

I. General information

NPI: 1841583952
Provider Name (Legal Business Name): C DEAN KATSAMAKIS DO FACC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2011
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WAUKEGAN RD
GLENVIEW IL
60025-5159
US

IV. Provider business mailing address

2720 DUNDEE RD # 290
NORTHBROOK IL
60062-2609
US

V. Phone/Fax

Practice location:
  • Phone: 847-904-7400
  • Fax: 847-904-7401
Mailing address:
  • Phone: 847-904-7400
  • Fax: 847-904-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CONSTANTINE DEAN KATSAMAKIS
Title or Position: OWNER
Credential: D.O.
Phone: 847-904-7400