Kostidis, Athena

Kostidis, Athena is an individual health care provider with primary practice located at 2160 S 1St Ave (17W740 22Nd Street, Oakbrook Terrace, Il. 60181), Maywood IL 60153. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Neurology, Allopathic & Osteopathic Physicians / Clinical Neurophysiology. Allopathic & Osteopathic Physicians / Neurology is her primary health care specialty. Kostidis, Athena can be contacted via phone (630) 627-7399.

Contact Information

Primary practice address
2160 S 1St Ave (17W740 22Nd Street, Oakbrook Terrace, Il. 60181) Maywood IL 60153
Phone: (630) 627-7399
Fax: (630) 627-7079
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neurology 2084N0400X 36113445 Illinois
Allopathic & Osteopathic Physicians / Clinical Neurophysiology 2084N0600X 36113445 Illinois

Profile Details

NPI number 1386624575
LBN Legal business name Kostidis, Athena
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 23rd, 2006
Last updated Oct 13th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386624575 NPPES
Illinois MEDICAID 36113445

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