MEDICARE: MARINOS KONTZIALIS

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	2085N0700X	Neuroradiology Physician	036-138788	IL
2	2085R0202X	Diagnostic Radiology Physician	036-138788	IL
3	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	036138788	IL

General Provider Information

NPI Number	:	1528214855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINOS KONTZIALIS

Provider Business Mailing Address
First Line	:	676 N SAINT CLAIR ST STE 1400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2951
Country	:	US
Telephone Number	:	312-695-1292
Fax Number	:	312-695-3999

Provider Business Practice Location Address
First Line	:	676 N SAINT CLAIR ST STE 1400
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-2951
Country	:	US
Telephone Number	:	312-695-1292
Fax Number	:	312-695-3999

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

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	09/24/2020

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Directions to “ MARINOS KONTZIALIS ” Practice Location

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