Healthcare Provider Details

I. General information

NPI: 1619991361
Provider Name (Legal Business Name): A. TOM PETROPULOS, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST SUITE 306
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

4400 W 95TH ST SUITE 306
OAK LAWN IL
60453-2654
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-5562
  • Fax: 708-346-2059
Mailing address:
  • Phone: 708-346-5562
  • Fax: 708-346-2059

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 Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: A. TOM PETROPULOS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 708-346-5562