MEDICARE: STAVROS ORESTIS ALEXOPOULOS D.P.M.

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	213E00000X	Podiatrist	016004298	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	60010812	OTHER	IL	BLUE SHIELD OF ILLINOIS

General Provider Information

NPI Number	:	1710102017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STAVROS ORESTIS ALEXOPOULOS D.P.M.

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE STE 107
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3543
Country	:	US
Telephone Number	:	773-561-8100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 W FOSTER AVE STE 107
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3543
Country	:	US
Telephone Number	:	773-561-8100
Fax Number	:

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

Provider Enumeration Date	:	04/13/2007
Last Update Date	:	07/08/2007

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