Healthcare Provider Details

I. General information

NPI: 1720169758
Provider Name (Legal Business Name): DEAN SPIROS ECONOMOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/16/2010
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 Number036099612
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: