Provider Demographics
NPI:1194968164
Name:CIMIS FELLOWSHIP
Entity type:Organization
Organization Name:CIMIS FELLOWSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:T
Authorized Official - Last Name:FRANTZIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD, FACS
Authorized Official - Phone:847-676-2200
Mailing Address - Street 1:4905 OLD ORCHARD CTR
Mailing Address - Street 2:SUITE 409
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1458
Mailing Address - Country:US
Mailing Address - Phone:847-676-2200
Mailing Address - Fax:847-676-1813
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:SUITE 409
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1458
Practice Address - Country:US
Practice Address - Phone:847-676-2200
Practice Address - Fax:847-676-1813
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHICAGO INSTITUTE OF MINIMALLY INVASIVE SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty