Healthcare Provider Details

I. General information

NPI: 1568547792
Provider Name (Legal Business Name): SPYRO C ANALITIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 N ROCKTON AVE
ROCKFORD IL
61103-3600
US

IV. Provider business mailing address

2350 N ROCKTON AVE
ROCKFORD IL
61103-3600
US

V. Phone/Fax

Practice location:
  • Phone: 815-971-5000
  • Fax: 815-971-9007
Mailing address:
  • Phone: 815-971-5000
  • Fax: 815-971-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: