Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 038-006760 | IL |
N | 111NS0005X | Chiropractic Sports Physician | 038-006760 | IL |
NPI | 1508998170 |
---|---|
Provider Name | Dr. Spyros Bakis |
First Address | Skokie, IL 60077-2568 |
Second Address | Chicago, IL 60607-2609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L76236 | (02) | IL |