Provider Demographics
NPI:1770937161
Name:VAMVOURIS, THEODORA (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORA
Middle Name:
Last Name:VAMVOURIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 600
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2981
Mailing Address - Country:US
Mailing Address - Phone:312-664-3278
Mailing Address - Fax:312-695-0063
Practice Address - Street 1:676 N SAINT CLAIR ST STE 600
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2981
Practice Address - Country:US
Practice Address - Phone:312-664-3278
Practice Address - Fax:312-695-0063
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT63646208M00000X
390200000X
IL036157462208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program