MEDICARE: DR. DEAN SPIROS ECONOMOS M.D.

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	036099612	IL

General Provider Information

NPI Number	:	1720169758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEAN SPIROS ECONOMOS M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	02/16/2010

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