Provider Demographics
NPI:1053336156
Name:MAKRIS, ANGELO (MD)
Entity type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:MAKRIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PASQUINELLI DR
Mailing Address - Street 2:
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-1382
Mailing Address - Country:US
Mailing Address - Phone:630-323-8690
Mailing Address - Fax:630-323-8657
Practice Address - Street 1:700 PASQUINELLI DR
Practice Address - Street 2:
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-1382
Practice Address - Country:US
Practice Address - Phone:630-323-8690
Practice Address - Fax:630-323-8657
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012396772085R0204X
IL036-0953642085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC019760A25Medicare PIN
ILIL6466001Medicare PIN
VA010797A68Medicare PIN
M46809Medicare UPIN