MEDICARE: PETER D. SOTIROPOULOS, AU.D. AND ASSOC, PC

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	231HA2500X	Assistive Technology Supplier Audiologist		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1700953817	OTHER	IL	NATIONAL PROVIDER NUMBER

General Provider Information

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

Provider Business Mailing Address
First Line	:	1455 W COURT ST
Second Line	:
City	:	KANKAKEE
State	:	IL
Zip	:	60901-3263
Country	:	US
Telephone Number	:	815-939-2024
Fax Number	:	815-939-3043

Provider Business Practice Location Address
First Line	:	29 W 34TH ST
Second Line	:
City	:	STEGER
State	:	IL
Zip	:	60475-1016
Country	:	US
Telephone Number	:	708-756-1767
Fax Number	:	708-756-1705

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER D SOTIROPOULOS
Credential	:	AU.D.
Telephone Number	:	708-756-1767

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	01/31/2008

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