Active NPI
Calliope C Andricacou, MD
- Pediatrics Physician
- Evergreen Park, IL
National Provider Identifier
1245345545
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 036058640
- Practice address
- 2850 W 95TH St
#404
Evergreen Park, IL 60805 - Phone
- (708) 423-4000
- Fax
- (708) 423-4097
- NPI assigned
- Aug 20, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 036058640 | IL | Primary |
Addresses
Primary practice location
2850 W 95TH St
#404
Evergreen Park, IL 60805
Mailing address
2850 W 95TH St
#404
Evergreen Park, IL 60805
Phone (708) 423-4000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21608967 | Other | IL | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036058640 | IL | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347321600000",
"number": "1245345545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2850 W 95TH ST",
"address_2": "#404",
"city": "EVERGREEN PARK",
"state": "IL",
"postal_code": "60805",
"telephone_number": "708-423-4000",
"fax_number": "708-423-4097"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2850 W 95TH ST",
"address_2": "#404",
"city": "EVERGREEN PARK",
"state": "IL",
"postal_code": "60805",
"telephone_number": "708-423-4000",
"fax_number": "708-423-4097"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDRICACOU",
"first_name": "CALLIOPE",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-08-20",
"last_updated": "2012-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IL",
"license": "036058640",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "21608967",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evergreen Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.