Provider Demographics
NPI:1992732630
Name:COSTAS, CHRIS O (MD)
Entity type:Individual
Prefix:
First Name:CHRIS
Middle Name:O
Last Name:COSTAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:546 W WELLINGTON AVE APT 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-0497
Mailing Address - Country:US
Mailing Address - Phone:773-671-1503
Mailing Address - Fax:
Practice Address - Street 1:6500 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-4097
Practice Address - Country:US
Practice Address - Phone:847-866-6338
Practice Address - Fax:847-491-1392
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL03666073207RI0200X
IL036067703207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG58780Medicare UPIN