Healthcare Provider Details

I. General information

NPI: 1467628461
Provider Name (Legal Business Name): DEAN S. ECONOMOS, MD, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 10/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 GRAND AVE
INGLESIDE IL
60041-9748
US

IV. Provider business mailing address

727 GRAND AVE
INGLESIDE IL
60041-9748
US

V. Phone/Fax

Practice location:
  • Phone: 847-973-9640
  • Fax: 847-973-9639
Mailing address:
  • Phone: 847-973-9640
  • Fax: 847-973-9639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN S ECONOMOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 847-973-9640