Dean S. Economos, MD, SC
Organization Active NPI Family Medicine Physician · Ingleside, IL
NPI 1467628461 · NPPES record last updated Oct 6, 2008
Key facts
- NPI
- 1467628461
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DEAN S. ECONOMOS, MD, SC
- Practice address
- 727 Grand Ave
Ingleside, IL 60041-9748 - Phone
- (847) 973-9640
- Fax
- (847) 973-9639
- NPI assigned
- Apr 30, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Dean S Economos, M.D.
- Title
- President
- Phone
- (847) 973-9640
Practitioners 5
-
Dean Spiros Economos, M.D.
-
Elvie J Lenth, PT
-
David R Bruah, MD
-
Crystal G Pauley, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080602000447 | IL | Part B Supplier - Clinic/Group Practice | 8921178047 |
Receives reassigned benefits from 2 practitioners Practice locations: Ingleside, IL |
National Provider Directory
Locations
727 Grand Ave
Ingleside, IL 60041
Phone (815) 477-8900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
727 Grand Ave
Ingleside, IL 60041-9748
Mailing address
727 Grand Ave
Ingleside, IL 60041-9748
Phone (847) 973-9640
Other providers in Ingleside, IL
- Big Hollow School District 38
- Cecelia Blue
- Michelle Elizabeth Dace
- Ethan Dennis Dahl
- William C Dam
- Domenico PLLC
- Jane Brigette Dorado
- Dean Spiros Economos
- Donna Marie Economos
- Fox Lake Fire Protection District
All providers in Ingleside, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.