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General NPI Number Information
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NPI Number | 1881877520
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Entity Type | Organization
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Legal Business Name | ANGELO TSAKOPOULOS MD SC
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Dates
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Enumeration Date | 12/17/2007
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 19550 GOVERNORS HWY SUITE 2700
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2125
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Country | US
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Telephone | 708-798-9170
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Fax | 708-798-9173
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Provider Business Mailing Address
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Address Line | PO BOX 1149
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City | MATTESON
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State | IL
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Zip | 60443-4149
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Country | US
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Telephone | 708-747-5850
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Fax | 708-747-9991
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Authorized Official
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Title or Position | MD
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Name | ANGELO G TSAKOPOULOS
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Credential | MD
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Telephone | 708-798-9170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036111440
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License Number State | IL
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