Healthcare Provider Details

I. General information

NPI: 1447215702
Provider Name (Legal Business Name): ROBERT H SORENSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 E WITCHWOOD LN
LAKE BLUFF IL
60044-2741
US

IV. Provider business mailing address

6 E WITCHWOOD LN
LAKE BLUFF IL
60044-2741
US

V. Phone/Fax

Practice location:
  • Phone: 847-295-4047
  • Fax:
Mailing address:
  • Phone: 847-295-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number32059-020
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: