Healthcare Provider Details

I. General information

NPI: 1144751751
Provider Name (Legal Business Name): DIMITRI PLIKAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 10/16/2020
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

904 S OWEN ST
MOUNT PROSPECT IL
60056-4342
US

V. Phone/Fax

Practice location:
  • Phone: 708-747-4000
  • Fax:
Mailing address:
  • Phone: 847-414-5690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036153417
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: