Provider Demographics
NPI:1154536647
Name:LEO SOTIRIOU, MD, LLC
Entity type:Organization
Organization Name:LEO SOTIRIOU, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTIRIOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-521-5630
Mailing Address - Street 1:250 EAST 300 SOUTH #330
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-2424
Mailing Address - Country:US
Mailing Address - Phone:801-521-5630
Mailing Address - Fax:801-596-9780
Practice Address - Street 1:250 EAST 300 SOUTH #330
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-2424
Practice Address - Country:US
Practice Address - Phone:801-521-5630
Practice Address - Fax:801-596-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT155029-1205207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057743OtherMEDICARE PTAN
UT005774301Medicare ID - Type Unspecified
UTC63340Medicare UPIN