Healthcare Provider Details

I. General information

NPI: 1295664001
Provider Name (Legal Business Name): SONNIA IDOKO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LAFAYETTE SUITE 3000
GRAND RAPIDS MI
49503
US

IV. Provider business mailing address

200 JEFFERSON SUITE 305
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-6919
  • Fax: 616-685-3063
Mailing address:
  • Phone: 616-685-4815
  • Fax: 616-685-3033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351056204
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: