Healthcare Provider Details

I. General information

NPI: 1649248931
Provider Name (Legal Business Name): GREGORY VICTOR SOBOL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17877 W 14 MILE RD
BEVERLY HILLS MI
48025-3127
US

IV. Provider business mailing address

26211 CENTRAL PARK BLVD STE 201
SOUTHFIELD MI
48076-4158
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-3920
  • Fax: 844-598-9632
Mailing address:
  • Phone: 833-667-3627
  • Fax: 833-972-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301074673
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number074673
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: