=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306984877
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ABLE PODIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/04/2007
-----------------------------------------------------
Last Update Date | 09/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 MEDICAL PKWY PROFESSIONAL PLAZA 4, SUITE 304
-----------------------------------------------------
City | FARMERS BRANCH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75234-7858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-223-0606
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P O BOX 38561
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75238-0561
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-223-0606
-----------------------------------------------------
Fax | 214-341-8846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ANASTASIOS SOTIROPOULOS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 469-223-0606
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0131X
-----------------------------------------------------
Taxonomy Name | Foot Surgery Podiatrist
-----------------------------------------------------
License Number | 1621
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------