MEDICARE: PIERCE MICHAEL PATERAKOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		IL

General Provider Information

NPI Number	:	1003759945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PIERCE MICHAEL PATERAKOS

Provider Business Mailing Address
First Line	:	2306 BIANCO TER
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60025-4800
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 31ST ST
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1235
Country	:	US
Telephone Number	:	630-971-6080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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