Basic Information
| Provider Information | |||||||||
| NPI: | 1194744995 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAPADOPOULOS | ||||||||
| FirstName: | DEAN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2998 MOMENTUM PLACE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60689 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626570222 | ||||||||
| FaxNumber: | 2626577190 | ||||||||
| Practice Location | |||||||||
| Address1: | 1294 S ROUTE 12 | ||||||||
| Address2: | |||||||||
| City: | FOX LAKE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600201950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479739440 | ||||||||
| FaxNumber: | 8479739442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 09/10/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 070-014551 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 1619908 | 01 | IL | BCBS IL GROUP | OTHER | 568150 | 01 | IL | MEDICARE GROUP NUMBER | OTHER | IL6697018 | 01 | IL | MEDICARE | OTHER | 567700 | 01 | IL | MEDICARE GOUP NUMBER | OTHER | IL6238020 | 01 | IL | MEDICARE | OTHER | IL6237020 | 01 | IL | MEDICARE | OTHER | 568080 | 01 | IL | MEDICARE GROUP NUMBER | OTHER |