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General NPI Number Information
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NPI Number | 1437161254
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Entity Type | Individual
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Provider Name | DIMITRIOS KOTSOPULOS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 12400 S HARLEM AVE STE 201
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1476
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Country | US
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Telephone | 708-923-9630
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Fax |
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Provider Business Mailing Address
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Address Line | 12400 S HARLEM AVE STE 201
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1476
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Country | US
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Telephone | 708-923-9630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016-004977
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000916A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 016-004977
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 07000916A
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License Number State | IN
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