1700953817 NPI number — PETER D. SOTIROPOULOS, AU.D. AND ASSOC, PC

Table of content: (NPI 1700953817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700953817 NPI number — PETER D. SOTIROPOULOS, AU.D. AND ASSOC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PETER D. SOTIROPOULOS, AU.D. AND ASSOC, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700953817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1455 W COURT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANKAKEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60901-3263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-939-2024
Provider Business Mailing Address Fax Number:
815-939-3043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 W 34TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEGER
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60475-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-756-1767
Provider Business Practice Location Address Fax Number:
708-756-1705
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SOTIROPOULOS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
708-756-1767

Provider Taxonomy Codes

  • Taxonomy code: 231HA2500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1700953817 . This is a "NATIONAL PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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