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General NPI Number Information
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NPI Number | 1063682466
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Entity Type | Individual
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Provider Name | RICHARD A SODETZ MD
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Gender | Male
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 641 S ASHLAND AVE UNIT J
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City | CHICAGO
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State | IL
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Zip | 60607-3167
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Country | US
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Telephone | 715-865-5002
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Fax |
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Provider Business Mailing Address
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Address Line | N5329 DUGAN LAKE ROAD PO BOX 297
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City | STONE LAKE
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State | WI
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Zip | 54876-0297
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Country | US
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Telephone | 715-865-5002
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State | IL
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