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NPI Code Detail

MEDICARE: JAMES S POULOS MD

MEDICARE: JAMES S POULOS MD
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
1207R00000XInternal Medicine PhysicianIL

General Provider Information

NPI Number : 1013910710
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES S POULOS MD
Provider Business Mailing Address
First Line : 7157 W HOWARD ST
Second Line :
City : NILES
State : IL
Zip : 60714-3757
Country : US
Telephone Number : 847-647-1771
Fax Number :
Provider Business Practice Location Address
First Line : 7157 W HOWARD ST
Second Line :
City : NILES
State : IL
Zip : 60714-3757
Country : US
Telephone Number : 847-647-1771
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 07/08/2007

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Directions to “ JAMES S POULOS MD” Practice Location

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