Basic Information
| Provider Information | |||||||||
| NPI: | 1083804033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THEODORE CHRISTOU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9050 W 81ST ST | ||||||||
| Address2: | |||||||||
| City: | JUSTICE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604581350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085630330 | ||||||||
| FaxNumber: | 7085630916 | ||||||||
| Practice Location | |||||||||
| Address1: | 9050 W 81ST ST | ||||||||
| Address2: | |||||||||
| City: | JUSTICE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604581350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7085630330 | ||||||||
| FaxNumber: | 7085630916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2007 | ||||||||
| LastUpdateDate: | 07/26/2007 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTOU | ||||||||
| AuthorizedOfficialFirstName: | THEODORE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7085630330 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.