Provider Demographics
NPI:1801885199
Name:SOTIRIOU, LEO (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:SOTIRIOU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:250 E 300 S
Mailing Address - Street 2:#330
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2418
Mailing Address - Country:US
Mailing Address - Phone:801-521-5630
Mailing Address - Fax:801-596-9780
Practice Address - Street 1:250 E 300 S
Practice Address - Street 2:#330
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2418
Practice Address - Country:US
Practice Address - Phone:801-521-5630
Practice Address - Fax:801-596-9780
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT155029 1205207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C63440Medicare UPIN