MEDICARE: ANASTASIOS SOTIROPOULOS DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	1621	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00217354	OTHER		MEDICARE RAILROAD
3	00393Y	OTHER	TX	MEDICARE GROUP ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0053JB	OTHER	TX	BLUE CROSS BLUE SHIELD
4	1621	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1174703425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANASTASIOS SOTIROPOULOS DPM

Provider Business Mailing Address
First Line	:	PO BOX 38561
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75238-0561
Country	:	US
Telephone Number	:	469-223-0606
Fax Number	:

Provider Business Practice Location Address
First Line	:	13021 COIT RD
Second Line	:	SUITE 200
City	:	DALLAS
State	:	TX
Zip	:	75240-5789
Country	:	US
Telephone Number	:	469-223-0606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2007
Last Update Date	:	12/03/2008

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Directions to “ ANASTASIOS SOTIROPOULOS DPM” Practice Location

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