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General NPI Number Information
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NPI Number | 1811080138
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Entity Type | Individual
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Provider Name | THEODORE POLIZOS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 09/30/2006
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Last Update Date | 07/15/2010
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Provider Practice Location Address
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Address Line | 2740 W FOSTER AVE SUITE #205
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City | CHICAGO
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State | IL
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Zip | 60625-3500
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Country | US
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Telephone | 773-271-9050
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Fax | 773-271-9051
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Provider Business Mailing Address
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Address Line | PO BOX 95727
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60195-0727
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Country | US
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Telephone | 773-271-9050
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Fax | 773-271-9051
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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 | 213EP0504X
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Taxonomy Name | Public Medicine Podiatrist
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License Number | 016004322
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 016004322
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 213ER0200X
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Taxonomy Name | Radiology Podiatrist
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License Number | 016004322
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | 016004322
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016004322
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License Number State | IL
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Taxonomy #6
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 016004322
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License Number State | IL
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