Healthcare Provider Details

I. General information

NPI: 1700953817
Provider Name (Legal Business Name): PETER D. SOTIROPOULOS, AU.D. AND ASSOC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 W 34TH ST
STEGER IL
60475-1016
US

IV. Provider business mailing address

1455 W COURT ST
KANKAKEE IL
60901-3263
US

V. Phone/Fax

Practice location:
  • Phone: 708-756-1767
  • Fax: 708-756-1705
Mailing address:
  • Phone: 815-939-2024
  • Fax: 815-939-3043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. PETER D SOTIROPOULOS
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 708-756-1767