Healthcare Provider Details

I. General information

NPI: 1437157955
Provider Name (Legal Business Name): SONJA M EARLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43205 WOODWARD AVE
BLOOMFIELD HILLS MI
48302-5006
US

IV. Provider business mailing address

PO BOX 44047
DETROIT MI
48244-0047
US

V. Phone/Fax

Practice location:
  • Phone: 248-451-0600
  • Fax: 248-451-0700
Mailing address:
  • Phone: 248-451-0600
  • Fax: 248-451-0700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301065586
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: