Individual provider Active NPI

Theodoros Michelakos, MD

  • Surgery Physician
  • Chicago, IL
National Provider Identifier
1639609878
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
036.169793 Issued in IL
Practice address
5841 S Maryland Ave RM O-217
Chicago, IL 60637-1443
Phone
(773) 896-6160
NPI assigned
Jun 19, 2017
Last updated
Jun 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 271229 MA
Surgery Physician 208600000X 036.169793 IL Primary

Addresses

Primary practice location

5841 S Maryland Ave RM O-217
Chicago, IL 60637-1443

Mailing address

180 Harvester Dr Ste 110
Burr Ridge, IL 60527-6686
Phone (773) 702-1150

Other practice location 1

Massachusetts General Hospital
55 Fruit St.
Boston, MA 02114
Phone (617) 726-2800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250514000459 IL Practitioner - Surgical OncologyPractitioner - General Surgery 2860765484 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Surgical OncologyAlso: General Surgery
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

1725 W Harrison St
Suite 818
Chicago, IL 60612-3895
Phone (312) 942-5500

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.169793ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The University of Chicago Medical Center CurrentSince Apr 30, 2025 Accepting new patients
Rush University Medical Group Surgery CurrentSince Jul 3, 2025 Accepting new patients
The University of Chicago Medical Center CurrentSince Apr 30, 2025 Accepting new patients
University of Chicago CurrentSince Apr 30, 2025 Accepting new patients

Locations

150 Harvester Dr
Ste 300
Burr Ridge, IL 60527
Phone (773) 702-1061

180 Harvester Dr
Ste 110
Burr Ridge, IL 60527
Phone (773) 702-1061

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

1725 W Harrison St
Ste 818
Chicago, IL 60612
Phone (312) 942-4444

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

120 N Oak St
Oak Brook Mall, IL 60521
Phone (630) 856-6700

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1639609878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 HARVESTER DR STE 110",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605276686",
            "telephone_number": "773-702-1150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5841 S MARYLAND AVE RM O-217",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606371443",
            "telephone_number": "773-896-6160"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Massachusetts General Hospital",
            "address_2": "55 Fruit St.",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02114",
            "country_code": "US",
            "telephone_number": "617-726-2800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MICHELAKOS",
        "first_name": "THEODOROS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-19",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MA",
            "license": "271229",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036.169793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.