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NPI Code Detail

MEDICARE: KOTIS AND KANELLOS LTD

MEDICARE: KOTIS AND KANELLOS LTD
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
1122300000XDentist060.005824IL

General Provider Information

NPI Number : 1104086008
Entity Type Code : Organization
Provider Name (Legal Business Name) : KOTIS AND KANELLOS LTD
Provider Business Mailing Address
First Line : 9206 S COMMERCIAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4508
Country : US
Telephone Number : 773-978-4447
Fax Number : 773-978-7662
Provider Business Practice Location Address
First Line : 9206 S COMMERCIAL AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60617-4508
Country : US
Telephone Number : 773-978-4447
Fax Number : 773-978-7662
Authorized Official
Title or Position : DENTIST/OWNER
Name : DR. JAMES P KANELLOS
Credential : DDS
Telephone Number : 773-978-4447
Provider Enumeration Date : 06/13/2008
Last Update Date : 06/13/2008

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Directions to “KOTIS AND KANELLOS LTD ” Practice Location

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