MEDICARE: DEAN S. ECONOMOS, MD, SC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1467628461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEAN S. ECONOMOS, MD, SC

Provider Business Mailing Address
First Line	:	727 GRAND AVE
Second Line	:
City	:	INGLESIDE
State	:	IL
Zip	:	60041-9748
Country	:	US
Telephone Number	:	847-973-9640
Fax Number	:	847-973-9639

Provider Business Practice Location Address
First Line	:	727 GRAND AVE
Second Line	:
City	:	INGLESIDE
State	:	IL
Zip	:	60041-9748
Country	:	US
Telephone Number	:	847-973-9640
Fax Number	:	847-973-9639

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEAN S ECONOMOS
Credential	:	M.D.
Telephone Number	:	847-973-9640

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	10/06/2008

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