Organization Name: | KEVIN C SORENSEN DPM PC |
NPI Number: | 1063874659 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KEVIN C SORENSEN (OWNER) |
Mailing Address: | 44000 W 12 Mile Rd Ste 111 Novi |
State: | MI US |
Postal Code: | 483772644 |
Phone Number: | 2483478233 |
Fax Number: | |
NPI Enumeration Date: | 03/23/2016 |
NPI Last Update Date: | 03/23/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 213ES0103X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
Taxonomy Classification: | Podiatrist |
Taxonomy Specialization: | Foot & Ankle Surgery |
Taxonomy Definition: |