Provider Demographics
NPI:1104948967
Name:CHRISTOPHER T. KARDASIS M.D., S.C.
Entity type:Organization
Organization Name:CHRISTOPHER T. KARDASIS M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:KARDASIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-799-3720
Mailing Address - Street 1:17850 KEDZIE AVE
Mailing Address - Street 2:DOCTORS PAVILION SUITE 1200
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-2058
Mailing Address - Country:US
Mailing Address - Phone:708-799-3720
Mailing Address - Fax:708-799-3733
Practice Address - Street 1:17850 KEDZIE AVE
Practice Address - Street 2:DOCTORS PAVILION SUITE 1200
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-2058
Practice Address - Country:US
Practice Address - Phone:708-799-3720
Practice Address - Fax:708-799-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01620286OtherBLUE CROSS BLUE SHIELD
IL=========30338OtherADVOCATE
ILG50965Medicare UPIN
ILK11142Medicare ID - Type Unspecified