Provider Demographics
NPI:1194744995
Name:PAPADOPOULOS, DEAN (DPT)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:PAPADOPOULOS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GREENFIELD REHAB AGENCY
Mailing Address - Street 2:3360 GATEWAY RD. SUITE 100
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045
Mailing Address - Country:US
Mailing Address - Phone:262-923-7101
Mailing Address - Fax:262-657-7190
Practice Address - Street 1:1294 S ROUTE 12
Practice Address - Street 2:
Practice Address - City:FOX LAKE
Practice Address - State:IL
Practice Address - Zip Code:60020-1950
Practice Address - Country:US
Practice Address - Phone:847-973-9440
Practice Address - Fax:847-973-9442
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-014551225100000X
WI13522225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6237020OtherMEDICARE
ILIL6697018OtherMEDICARE
IL1619908OtherBCBS IL GROUP
IL568080OtherMEDICARE GROUP NUMBER
IL568150OtherMEDICARE GROUP NUMBER
IL567700OtherMEDICARE GOUP NUMBER
ILIL6238020OtherMEDICARE
ILIL6237020OtherMEDICARE
ILK49494Medicare PIN
ILIL6238020OtherMEDICARE