Provider Demographics
NPI:1972605632
Name:CHRIS O. COSTAS, M.D. SC
Entity type:Organization
Organization Name:CHRIS O. COSTAS, M.D. SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWOOPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-866-6338
Mailing Address - Street 1:800 AUSTIN ST
Mailing Address - Street 2:WEST TOWER - SUITE 201A
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3439
Mailing Address - Country:US
Mailing Address - Phone:847-866-6338
Mailing Address - Fax:847-491-1392
Practice Address - Street 1:800 AUSTIN ST
Practice Address - Street 2:WEST TOWER - SUITE 201A
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3439
Practice Address - Country:US
Practice Address - Phone:847-866-6338
Practice Address - Fax:847-491-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG58780Medicare UPIN