Basic Information
| Provider Information | |||||||||
| NPI: | 1689811978 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KARANASTASIS | ||||||||
| FirstName: | GEORGIOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12800 S RIDGELAND AVE STE E | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604632391 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12800 S RIDGELAND AVE STE E | ||||||||
| Address2: | |||||||||
| City: | PALOS HEIGHTS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604632391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084293700 | ||||||||
| FaxNumber: | 7084294460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2009 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 036122134 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036122134 | 01 | IL | ILLINOIS STATE LICENSE | OTHER |