Healthcare Provider Details

I. General information

NPI: 1033430640
Provider Name (Legal Business Name): RAYMOND SETH SOHN D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2124 KOHLER MEMORIAL DR STE 110
SHEBOYGAN WI
53081-3174
US

IV. Provider business mailing address

DEPT CH 17057
PALATINE IL
60055-7057
US

V. Phone/Fax

Practice location:
  • Phone: 920-204-6758
  • Fax: 888-720-0495
Mailing address:
  • Phone: 920-204-6758
  • Fax: 414-325-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number68489
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberDR.0055453
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberDR.0055453
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: