Provider Demographics
NPI:1427859206
Name:ICARUSMD PLLC
Entity type:Organization
Organization Name:ICARUSMD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:MOUSTOUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-669-1233
Mailing Address - Street 1:898 ASH ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2436
Mailing Address - Country:US
Mailing Address - Phone:504-669-1233
Mailing Address - Fax:
Practice Address - Street 1:770 E DUNDEE RD
Practice Address - Street 2:
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074-2858
Practice Address - Country:US
Practice Address - Phone:504-669-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-19
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine