Healthcare Provider Details

I. General information

NPI: 1245268945
Provider Name (Legal Business Name): KRIS S. SORNBERGER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KRIS S SORNBERGER DO

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CUMBERLAND PL STE 112
BANGOR ME
04401-5083
US

IV. Provider business mailing address

1 CUMBERLAND PL STE 112
BANGOR ME
04401-5083
US

V. Phone/Fax

Practice location:
  • Phone: 207-307-0816
  • Fax: 207-637-1072
Mailing address:
  • Phone: 207-307-0816
  • Fax: 207-637-1072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number1872
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1872
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: