DR. KOSTANTINOS PANTELIS POULIKIDIS (NPI# 1689018830) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689018830 |
| Entity Type | Individual |
| Full Name | DR. KOSTANTINOS PANTELIS POULIKIDIS |
| Credential | M.D. |
| Practice Address |
2160 S 1st Ave Maywood IL 60153 |
| Mailing Address |
2160 S 1st Ave Maywood IL 60153-3328 |
| Practice Telephone | 7083272437 |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2018-08-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 036.145990 | IL | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | AS2383278 - 0842 | CT | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 30 Shelburne Rd, Stamford Hospital, Department of Surgery, Stamford, CT 069023628 | 2032767467 | 2032767020 |
| Street Address |
2160 S 1ST AVE |
| City | MAYWOOD |
| State | IL |
| Zip Code | 60153 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174525489 | Michael Jm Raffin | Audiologist | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2005-06-01 |
| 1366049900 | Kenneth Bernard Jordan | Psychiatry & Neurology | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-10-06 |
| 1124634712 | Abhilasha Nitin Borkar | Pathology | 2160 S 1st Ave, Maywood, IL 60153 | 2020-09-18 |
| 1306450325 | Linda Ippolito | Nurse Practitioner | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-09-08 |
| 1194339135 | Meghan Henry | Nurse Practitioner | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-09-08 |
| 1194339911 | Victoria Leah Drozd | Student in an Organized Health Care Education/Training Program | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-08-31 |
| 1396357588 | Madison Schaefer | Nurse Practitioner | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-08-19 |
| 1134731375 | Otanthia S Williams-brady | Nurse Practitioner | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-08-19 |
| 1205454287 | Janet Nickels | Audiologist | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-07-07 |
| 1417574054 | Kathryn Clemans | Nurse Anesthetist, Certified Registered | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2020-06-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053933077 | Judie Noemie Hoilat | Internal Medicine | 2160 S 1st Avenue, Maywood, IL 60153 | 2020-05-13 |
| 1457972457 | Yuchen Zheng | Student in an Organized Health Care Education/Training Program | Department of Neurology, Loyola University Medical Cent, 2160 S. First Ave, Maywood, IL 60153 | 2020-04-30 |
| 1437779519 | Amna Amad Siddiqui | Student in an Organized Health Care Education/Training Program | 2160 S. First Avenue, Loyola University Medical Center, Maywood, IL 60153 | 2020-04-20 |
| 1982232211 | Brian Kurtz | Student in an Organized Health Care Education/Training Program | 2160 S First Ave, Bulding 105-suite 2840a, Maywood, IL 60153 | 2020-03-31 |
| 1902434947 | Saadiya Jabbar | Psychiatry & Neurology | Loyola University Medical Center, Building 105, Suite 1940, Maywood, IL 60153 | 2020-03-27 |
| 1558919472 | Linda Sue Moton | Technician | 10 South 15 Apt. 1, Maywood, IL 60153 | 2019-09-04 |
| 1760047518 | Braden Robert Dasovic | Student in an Organized Health Care Education/Training Program | 2160 S. First Avenue Building 105/room 2700, Department, Loyola Medical Center, Maywood, IL 60153 | 2019-05-07 |
| 1134680713 | Madeline Shaoyun Tiee | Orthopaedic Surgery | Loyola University Medical Center, 2160 S 1st Ave, Maywood, IL 60153 | 2019-03-27 |
| 1538629746 | Michael Murphy | Orthopaedic Surgery | 2160 S 1st Ave., Maguire Center, Dept of Ortho Surg, Maywood, IL 60153 | 2019-03-22 |
| 1053871681 | Michael V Padua | Psychiatry & Neurology | 2160 S 1st Ave Bldg, Maywood, IL 60153 | 2019-03-20 |
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| Taxonomy Code | 208G00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
| A thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Thoracic Surgery, 2007. http://www.abts.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Thoracic Surgery. Thoracic surgeons have the knowledge, experience and technical skills to accurately diagnose, operate upon safely, and effectively manage patients with thoracic diseases of the chest. This requires substantial knowledge of cardiorespiratory physiology and oncology, as well as capability in the use of heart assist devices, management of abnormal heart rhythms and drainage of the chest cavity, respiratory support systems, endoscopy and invasive and noninvasive diagnostic techniques. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972576833 | Edwin C. Mcgee | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2160 S 1st Ave Bldg 110, #6243, Maywood, IL 60153-3328 | 2006-02-10 |
| 1184102618 | Emily Saha | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2018-08-06 |
| 1730507427 | Issa Rezek | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2160 S 1st Ave, Maywood, IL 60153 | 2014-03-31 |
| 1104063213 | Wissam Raad | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2009-01-12 |
| 1518113562 | Syed O Ali | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2008-08-11 |
| 1992919914 | Mamdouh Bakhos | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2160 S 1st Ave, Chief of Staff Office, Maywood, IL 60153-3328 | 2007-05-09 |
| 1790850683 | Young Sop Pae | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 318 Madison St, Maywood, IL 60153-2151 | 2006-11-23 |
| 1174542773 | Richard K Freeman | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2160 S 1st Ave, Maywood, IL 60153-3328 | 2006-07-18 |
| 1114906294 | Jeffrey Paul Schwartz | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2160 S First Ave, 110-6246, Loyola University Medical Center, Maywood, IL 60153 | 2006-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205363041 | Sachowdhry | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1 S Summit Ave, Oakbrook Terrace, IL 60181-2212 | 2017-05-11 |
| 1760930028 | Hiroto Kitahara | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5841 S. Maryland Avenue M/c6040, Chicago, IL 60637 | 2016-09-15 |
| 1720440282 | Azad Karim | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 441 E Erie St Apt 1803441, Chicago, IL 60611-4446 | 2016-03-24 |
| 1982002838 | Milton Weinberg Jr. | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 983 Kirkhill Ln, Lake Forest, IL 60045-4209 | 2014-12-09 |
| 1235557190 | Bartlomiej Imielski | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 201 E. Huron St., Galter 11-140, Chicago, IL 60611 | 2014-03-28 |
| 1841635869 | Aaron Maxwell Kime | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 133 E Brush Hill Rd Ste 200, Elmhurst, IL 60126-5661 | 2013-05-03 |
| 1952744823 | Walter Lee Barker | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 2912 N. Commonwealth Ave., #11c, Chicago, IL 60657-6235 | 2013-04-10 |
| 1952641649 | Willard A Fry | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1500 Sheridan Rd, #10e, Wilmette, IL 60091-1873 | 2013-02-18 |
| 1487903092 | Horizons In Healthcare LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 372 Red Bud Ct., Frankfort, IL 60423-2128 | 2012-08-29 |
| 1518215284 | Paul Naffah | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 6161 So County Line Rd, Burr Ridge, IL 60527 | 2012-08-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.