Provider Demographics
NPI:1780097105
Name:SOTIRIOU, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SOTIRIOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EAST 300 SOUTH, SUITE 120
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2544
Mailing Address - Country:US
Mailing Address - Phone:801-521-5630
Mailing Address - Fax:801-596-9780
Practice Address - Street 1:250 E 300 S STE 120
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2544
Practice Address - Country:US
Practice Address - Phone:801-521-5630
Practice Address - Fax:801-596-9780
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.145756207N00000X
UT11744110-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty