Healthcare Provider Details

I. General information

NPI: 1477581452
Provider Name (Legal Business Name): EDWIN ANTONIO SOTO-PESANTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2463 S. M-30
WEST BRANCH MI
48661
US

IV. Provider business mailing address

2488 W BRANCH DR
WEST BRANCH MI
48661-9278
US

V. Phone/Fax

Practice location:
  • Phone: 989-345-3660
  • Fax: 989-343-1791
Mailing address:
  • Phone: 989-343-1695
  • Fax: 989-343-1695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number4301075330
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301075330
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: