Basic Information
Provider Information
NPI: 1568547792
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ANALITIS
FirstName: SPYRO
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2350 N ROCKTON AVE
Address2:  
City: ROCKFORD
State: IL
PostalCode: 611033600
CountryCode: US
TelephoneNumber: 8159715000
FaxNumber: 8159719007
Practice Location
Address1: 2350 N ROCKTON AVE
Address2:  
City: ROCKFORD
State: IL
PostalCode: 611033600
CountryCode: US
TelephoneNumber: 8159715000
FaxNumber: 8159719007
Other Information
ProviderEnumerationDate: 10/26/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2086S0127X ILY Allopathic & Osteopathic PhysiciansSurgeryTrauma Surgery

No ID Information.


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