MEDICARE: ANTHONY D PAPADATOS MD, MBA

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	01059771A	IN
2	207P00000X	Emergency Medicine Physician	036.112284	IL

General Provider Information

NPI Number	:	1639117344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTHONY D PAPADATOS MD, MBA

Provider Business Mailing Address
First Line	:	505 N LAKE SHORE DR APT 6101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3429
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 N LAKE SHORE DR APT 6101
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3429
Country	:	US
Telephone Number	:	312-828-9552
Fax Number	:

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	05/24/2021

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