Organization
LEO SOTIRIOU, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEO SOTIRIOU M.D. (PHYSICIAN)
(801) 521-5630
Entity
Organization
Contact information
Practice address
250 EAST 300 SOUTH #330, SALT LAKE CITY, UT 84111-2424
(801) 521-5630
(801) 596-9780
Mailing address
250 EAST 300 SOUTH #330, SALT LAKE CITY, UT 84111-2424
(801) 521-5630
(801) 596-9780
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
155029-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000057743
MEDICARE PTAN
UT
Enumeration date
05/10/2007
Last updated
01/04/2012
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