Provider Demographics
NPI:1871617969
Name:BAKOS, JAMES LOUIS (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LOUIS
Last Name:BAKOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 W. CERMAK ROAD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2172
Mailing Address - Country:US
Mailing Address - Phone:708-795-5552
Mailing Address - Fax:
Practice Address - Street 1:6905 W. CERMAK ROAD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2172
Practice Address - Country:US
Practice Address - Phone:708-795-5552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL316000660213ES0131X
IL016.003002213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
626940Medicare PIN
T37327Medicare UPIN