Provider Demographics
NPI:1215966684
Name:STAVRAKOS, JOHN J (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:STAVRAKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:720 OSTERMAN AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4339
Mailing Address - Country:US
Mailing Address - Phone:847-945-3335
Mailing Address - Fax:847-945-3033
Practice Address - Street 1:720 OSTERMAN AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4471
Practice Address - Country:US
Practice Address - Phone:847-945-3030
Practice Address - Fax:847-945-3033
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2024-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36098718207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098718Medicaid
ILG91286Medicare UPIN
ILL70332Medicare PIN