Healthcare Provider Details

I. General information

NPI: 1215982269
Provider Name (Legal Business Name): SOSALE BERKUCHEL MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 S MORSE ST
SANDUSKY MI
48471-1331
US

IV. Provider business mailing address

3061 CHRISTY WAY C.O PRO MED BILLING
SAGINAW MI
48603-2267
US

V. Phone/Fax

Practice location:
  • Phone: 810-648-4405
  • Fax:
Mailing address:
  • Phone: 989-791-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301042585
License Number StateMI

VIII. Authorized Official

Name: SOSALE BERKUCHEL
Title or Position: OWNER
Credential: MD
Phone: 810-648-4733