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General NPI Number Information
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NPI Number | 1487363503
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Entity Type | Organization
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Legal Business Name | DREAM WIZARDS, PC
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Dates
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Enumeration Date | 11/17/2022
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Last Update Date | 11/17/2022
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Provider Practice Location Address
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Address Line | 1701 E EMPIRE ST STE 360-244
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City | BLOOMINGTON
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State | IL
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Zip | 61704-3532
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 E EMPIRE ST STE 360-244
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City | BLOOMINGTON
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State | IL
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Zip | 61704-3532
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. IOANNIS KARKATZOUNIS
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Credential | MD
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Telephone | 312-730-8637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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