Healthcare Provider Details

I. General information

NPI: 1861463242
Provider Name (Legal Business Name): MICHAEL D SORONEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 MLK JR WAY # 11
TACOMA WA
98405-4499
US

IV. Provider business mailing address

314 MLK JR WAY STE 11
TACOMA WA
98405
US

V. Phone/Fax

Practice location:
  • Phone: 253-627-6172
  • Fax: 253-627-8792
Mailing address:
  • Phone: 253-627-6172
  • Fax: 253-627-8792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD00013489
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: