Healthcare Provider Details

I. General information

NPI: 1841243680
Provider Name (Legal Business Name): CARLOS A SOTELO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 N COVE BLVD
TOLEDO OH
43606-3895
US

IV. Provider business mailing address

953 ARBORETUM DR
SALINE MI
48176-1352
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-4101
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34-008909
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number013218
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: