Healthcare Provider Details

I. General information

NPI: 1992765101
Provider Name (Legal Business Name): DENNIS MICHAEL SOSENKO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC 1585 3RD ST
FORT POLK LA
71459-5110
US

IV. Provider business mailing address

1215 ANDERSON DR
LEESVILLE LA
71446-3721
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-3529
  • Fax:
Mailing address:
  • Phone: 337-239-7657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: