Healthcare Provider Details

I. General information

NPI: 1891285235
Provider Name (Legal Business Name): JASON R SOTZEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2018
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2256 W HILL RD
FLINT MI
48507-4655
US

IV. Provider business mailing address

1804 VIOLA DR
ORTONVILLE MI
48462-8847
US

V. Phone/Fax

Practice location:
  • Phone: 810-249-7546
  • Fax: 734-464-0335
Mailing address:
  • Phone: 248-421-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4301506266
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: