Individual
SOTERIOS G POLYCHRONOPOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11638 S WESTERN AVE, CHICAGO, IL 60643
(773) 445-2422
(773) 445-5182
Mailing address
11638 S WESTERN AVE, CHICAGO, IL 60643
(773) 445-2422
(773) 445-5182
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
036051757
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036051757
—
IL
01
—
110019213
RR
IL
01
—
31602250
BC-BS
IL
Enumeration date
08/16/2005
Last updated
11/08/2016
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