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General NPI Number Information
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NPI Number | 1336110022
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Entity Type | Individual
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Provider Name | TELLY PSARADELLIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 04/24/2009
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Provider Practice Location Address
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Address Line | 2850 S WABASH AVE SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60616-2955
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Country | US
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Telephone | 312-842-4600
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Fax | 312-842-8694
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Provider Business Mailing Address
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Address Line | 2850 S WABASH AVE SUITE 100
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City | CHICAGO
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State | IL
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Zip | 60616-2955
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Country | US
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Telephone | 312-842-4600
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Fax | 312-842-8694
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 036-113086
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License Number State | IL
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