MEDICARE: VASSILIOS A. DIMITROPOULOS M.D.

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	207N00000X	Dermatology Physician	036113849	IL
2	207N00000X	Dermatology Physician	01084831A	IN
3	207ND0101X	MOHS-Micrographic Surgery Physician	036113849	IL
4	207NS0135X	Procedural Dermatology Physician	036113849	IL
5	207N00000X	Dermatology Physician	4301079801	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27-0422873	OTHER	MI	ST JOSEPH DERMATOLOGY TAX ID
2	813288715	OTHER	IL	UNIVERSITY DERMATOLOGY AND VEIN CLINIC
3	27-0907956	OTHER	IL	UNIVERSITY DERMATOLOGY TAX ID
4	813301692	OTHER	MI	ST JOSEPH DERMATOLOGY AND VEIN CLINIC
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194838045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VASSILIOS A. DIMITROPOULOS M.D.

Provider Business Mailing Address
First Line	:	745 S PARK AVE
Second Line	:
City	:	HINSDALE
State	:	IL
Zip	:	60521-4645
Country	:	US
Telephone Number	:	630-920-1900
Fax Number	:	630-920-1901

Provider Business Practice Location Address
First Line	:	10282 W 400 N
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9470
Country	:	US
Telephone Number	:	773-351-2862
Fax Number	:	773-358-2767

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	10/23/2020

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