Harry Paul Poulos, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036062775 Issued in IL

Practice address

3019 Old Glenview Rd
Wilmette, IL 60091-2908

Phone

(312) 423-4200

Fax

(847) 251-4348

NPI assigned

Aug 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278374400000",
    "number": "1740299346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3019 OLD GLENVIEW RD",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912908",
            "telephone_number": "312-423-4200",
            "fax_number": "847-251-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3019 OLD GLENVIEW RD",
            "city": "WILMETTE",
            "state": "IL",
            "postal_code": "600912908",
            "telephone_number": "312-423-4200",
            "fax_number": "847-251-4348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POULOS",
        "first_name": "HARRY",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2010-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036062775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Wilmette, IL
• Providers in Wilmette, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.