Provider Demographics
NPI:1700953817
Name:PETER D. SOTIROPOULOS, AU.D. AND ASSOC, PC
Entity type:Organization
Organization Name:PETER D. SOTIROPOULOS, AU.D. AND ASSOC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:SOTIROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:708-756-1767
Mailing Address - Street 1:1455 W COURT ST
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3263
Mailing Address - Country:US
Mailing Address - Phone:815-939-2024
Mailing Address - Fax:815-939-3043
Practice Address - Street 1:29 W 34TH ST
Practice Address - Street 2:
Practice Address - City:STEGER
Practice Address - State:IL
Practice Address - Zip Code:60475-1016
Practice Address - Country:US
Practice Address - Phone:708-756-1767
Practice Address - Fax:708-756-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231HA2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1700953817OtherNATIONAL PROVIDER NUMBER
IL214331Medicare PIN