Healthcare Provider Details

I. General information

NPI: 1043662018
Provider Name (Legal Business Name): SONU JOSEPH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2016
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

434 E PALATINE RD
PALATINE IL
60074-5119
US

IV. Provider business mailing address

434 E PALATINE RD
PALATINE IL
60074-5119
US

V. Phone/Fax

Practice location:
  • Phone: 847-398-0900
  • Fax: 847-398-0973
Mailing address:
  • Phone: 847-398-0900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002649
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: