MEDICARE: DR. GRETCHEN DENISE SONNENBERG DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	DR.0067281	CO
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1295227627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETCHEN DENISE SONNENBERG DO

Provider Business Mailing Address
First Line	:	3205 N ACADEMY BLVD STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5152
Country	:	US
Telephone Number	:	719-632-5799
Fax Number	:

Provider Business Practice Location Address
First Line	:	HEALTH CENTER AT MYRON STRATTON
Second Line	:	410 GOLD PASS HEIGHTS
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3882
Country	:	US
Telephone Number	:	719-632-5700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2018
Last Update Date	:	07/13/2023

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