Healthcare Provider Details

I. General information

NPI: 1497735351
Provider Name (Legal Business Name): ERROL I SOSKOLNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E HURON RIVER DR
YPSILANTI MI
48197-1051
US

IV. Provider business mailing address

5301 E HURON RIVER DR
YPSILANTI MI
48197-1051
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-3325
  • Fax: 734-712-5525
Mailing address:
  • Phone: 734-712-3325
  • Fax: 734-712-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301046969
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: