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General NPI Number Information
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NPI Number | 1982889051
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Entity Type | Organization
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Legal Business Name | NICHOLAS ANGELOPOULOS DO SC
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 6850 CENTENNIAL DR
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City | TINLEY PARK
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State | IL
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Zip | 60477-1653
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Country | US
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Telephone | 708-429-3466
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Fax | 708-429-3422
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Provider Business Mailing Address
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Address Line | 6850 CENTENNIAL DR
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City | TINLEY PARK
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State | IL
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Zip | 60477-1653
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Country | US
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Telephone | 708-429-3466
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Fax | 708-429-3422
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Authorized Official
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Title or Position | OWNER
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Name | NICHOLAS A ANGELOPOULOS
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Credential | DO
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Telephone | 708-429-3466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 036089214
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License Number State | IL
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