MEDICARE: DR. MICHAEL PAPADIMITRIOU D.D.S.

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	122300000X	Dentist	019026374	IL
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	019026374	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396993945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PAPADIMITRIOU D.D.S.

Provider Business Mailing Address
First Line	:	2440 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4113
Country	:	US
Telephone Number	:	773-761-7171
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 W PETERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-4113
Country	:	US
Telephone Number	:	773-761-7171
Fax Number	:

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

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	03/13/2025

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Directions to “ DR. MICHAEL PAPADIMITRIOU D.D.S.” Practice Location

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