Healthcare Provider Details

I. General information

NPI: 1558470328
Provider Name (Legal Business Name): MILAN SOSNOVEC, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12250 SW 2ND ST
BEAVERTON OR
97005-2828
US

IV. Provider business mailing address

3439 NE SANDY BLVD PMB 375
PORTLAND OR
97232-1959
US

V. Phone/Fax

Practice location:
  • Phone: 503-292-6238
  • Fax: 503-601-0049
Mailing address:
  • Phone: 503-284-8841
  • Fax: 503-282-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MILAN SOSNOVEC
Title or Position: PRESIDENT
Credential: MD
Phone: 503-284-8841