Healthcare Provider Details

I. General information

NPI: 1801002324
Provider Name (Legal Business Name): MICHAEL ANDREW SONNENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

PO BOX 9210
PENSACOLA FL
32513-9210
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-6020
  • Fax:
Mailing address:
  • Phone: 850-476-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301086534
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME122246
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: