Provider Demographics
NPI:1154310118
Name:SOTIROPOULOS, PETER D (AUD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:D
Last Name:SOTIROPOULOS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:1455 W COURT ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3263
Practice Address - Country:US
Practice Address - Phone:815-939-2024
Practice Address - Fax:815-939-3043
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X, 231HA2500X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology Supplier
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK32342Medicare PIN
ILK32336Medicare PIN