Provider Demographics
NPI:1265427942
Name:PAPPAS, PATROKLOS STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:PATROKLOS
Middle Name:STEVEN
Last Name:PAPPAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAT
Other - Middle Name:STEVEN
Other - Last Name:PAPPAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9500 BORMET DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8399
Mailing Address - Country:US
Mailing Address - Phone:708-346-4044
Mailing Address - Fax:708-346-3287
Practice Address - Street 1:4400 W 95TH ST STE 308
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2660
Practice Address - Country:US
Practice Address - Phone:708-346-4040
Practice Address - Fax:708-346-3287
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071743208G00000X, 208600000X
IN01043554A208600000X, 208G00000X
WI55179-20208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265427942Medicaid
WI1265427942Medicaid
IN200061020CMedicaid
IN200061020DMedicaid
IN200061020AMedicaid
IN200061020EMedicaid
IL036071743Medicaid
IN200061020BMedicaid
IN200061020AMedicaid
IL535550005Medicare PIN
IN780002108Medicare PIN
IN200061020CMedicaid
ILE43659Medicare UPIN
IL036071743Medicaid
IL921671Medicare PIN
MI1265427942Medicaid
IL060017056Medicare PIN