Healthcare Provider Details

I. General information

NPI: 1174795843
Provider Name (Legal Business Name): MILAN SOSNOVEC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 SW 2ND ST SUITE #102
BEAVERTON OR
97005-2828
US

IV. Provider business mailing address

12250 SW 2ND ST SUITE #102
BEAVERTON OR
97005-2828
US

V. Phone/Fax

Practice location:
  • Phone: 503-292-6238
  • Fax: 503-601-0049
Mailing address:
  • Phone: 503-292-6238
  • Fax: 503-601-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD10928
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: