Healthcare Provider Details

I. General information

NPI: 1225075393
Provider Name (Legal Business Name): YORAM SOROKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R 7 BRUSH NORTH, BOX 163
DETROIT MI
48201
US

IV. Provider business mailing address

1420 STEPHENSON HWY SUITE 400-CREDENTIALING
TROY MI
48083-1189
US

V. Phone/Fax

Practice location:
  • Phone: 313-993-1388
  • Fax: 313-993-4100
Mailing address:
  • Phone: 248-581-5970
  • Fax: 248-581-5640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301054820
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number4301054820
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: