Spyridon P Theodorakis, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036058530 Issued in IL

Practice address

5011 N Lincoln Ave
Chicago, IL 60625-2611

Phone

(773) 561-7710

Fax

(773) 561-7760

NPI assigned

Aug 10, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1287360000000",
    "number": "1922009059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5011 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252611",
            "telephone_number": "773-561-7710",
            "fax_number": "773-561-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5011 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252611",
            "telephone_number": "773-561-7710",
            "fax_number": "773-561-7760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THEODORAKIS",
        "first_name": "SPYRIDON",
        "middle_name": "P",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-10",
        "last_updated": "2010-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036058530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1617875",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36058530",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Noelle Thele
• Anna Thelen
• Ryn Thelen, LPC
• Sarah Jeanette Thelen, MS, RD, LDN
• Jill M Thennes, CCCSLPL
• Theodore Handrup MD LTD
• Theodore Harris, LCSW, LLC
• Theodore M. Siegel D.D.S., P.C.
• Theodore Polizos DPM Comprehensive Podiatric Medical Services, LTD.
• Theodore S. Wright, MD

• Surgery Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.