Healthcare Provider Details

I. General information

NPI: 1518898782
Provider Name (Legal Business Name): OBEC ISRAEL SOSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 BALL AVE NE
GRAND RAPIDS MI
49505-5904
US

IV. Provider business mailing address

2250 SAGINAW RD SE
GRAND RAPIDS MI
49506-5440
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-6571
  • Fax: 616-456-5800
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: