Healthcare Provider Details

I. General information

NPI: 1427013994
Provider Name (Legal Business Name): CARL EUGENE SOECHTIG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 BOSTON ST SE
GRAND RAPIDS MI
49506-4160
US

IV. Provider business mailing address

1919 BOSTON ST SE
GRAND RAPIDS MI
49506-4160
US

V. Phone/Fax

Practice location:
  • Phone: 616-252-7167
  • Fax: 616-252-6297
Mailing address:
  • Phone: 616-252-7167
  • Fax: 616-252-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number5101004945
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: