Healthcare Provider Details

I. General information

NPI: 1881862324
Provider Name (Legal Business Name): MILTON D SODERBERG MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVE STE 109
MARQUETTE MI
49855-5404
US

IV. Provider business mailing address

1414 W FAIR AVE STE 109
MARQUETTE MI
49855-5404
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3939
  • Fax: 906-225-7488
Mailing address:
  • Phone: 906-225-3939
  • Fax: 906-225-7488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMS026190
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberMS026190
License Number StateMI

VIII. Authorized Official

Name: DR. MILTON D SODERBERG
Title or Position: PHYSICIAN
Credential: MD
Phone: 906-225-3939