Provider Demographics
NPI:1538231782
Name:THEODORE POLIZOS DPM COMPREHENSIVE PODIATRIC MEDICAL SERVICES, LTD.
Entity type:Organization
Organization Name:THEODORE POLIZOS DPM COMPREHENSIVE PODIATRIC MEDICAL SERVICES, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIZOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-271-9050
Mailing Address - Street 1:PO BOX 95727
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-0727
Mailing Address - Country:US
Mailing Address - Phone:773-271-9050
Mailing Address - Fax:773-271-9051
Practice Address - Street 1:2740 W FOSTER AVE
Practice Address - Street 2:SUITE #205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3500
Practice Address - Country:US
Practice Address - Phone:773-271-9050
Practice Address - Fax:773-271-9051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01608070OtherBLUE CROSS BLUE SHIELD
IL1312440001Medicare NSC
IL932943Medicare PIN