Healthcare Provider Details

I. General information

NPI: 1457311524
Provider Name (Legal Business Name): STEPHEN CARL SORENSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 10/13/2022
Certification Date: 10/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 ELA RD STE 115
LAKE ZURICH IL
60047
US

IV. Provider business mailing address

1670 CAPITAL ST SUITE 500
ELGIN IL
60124-7837
US

V. Phone/Fax

Practice location:
  • Phone: 847-550-4984
  • Fax: 847-847-7289
Mailing address:
  • Phone: 847-468-9900
  • Fax: 847-468-9901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number036-092571
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036092571
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: