MEDICARE: SOTERIOS G POLYCHRONOPOULOS MD

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	207RP1001X	Pulmonary Disease Physician	036051757	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	110019213	OTHER	IL	RR
3	31602250	OTHER	IL	BC-BS

General Provider Information

NPI Number	:	1346232493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOTERIOS G POLYCHRONOPOULOS MD

Provider Business Mailing Address
First Line	:	11638 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643
Country	:	US
Telephone Number	:	773-445-2422
Fax Number	:	773-445-5182

Provider Business Practice Location Address
First Line	:	11638 S WESTERN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643
Country	:	US
Telephone Number	:	773-445-2422
Fax Number	:	773-445-5182

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	11/08/2016

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Directions to “ SOTERIOS G POLYCHRONOPOULOS MD” Practice Location

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