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General NPI Number Information
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NPI Number | 1063874659
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Entity Type | Organization
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Legal Business Name | KEVIN C SORENSEN DPM PC
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 44000 W 12 MILE RD STE 111
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City | NOVI
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State | MI
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Zip | 48377-2644
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Country | US
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Telephone | 248-347-8233
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Fax |
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Provider Business Mailing Address
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Address Line | 44000 W 12 MILE RD STE 111
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City | NOVI
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State | MI
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Zip | 48377-2644
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Country | US
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Telephone | 248-347-8233
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN C SORENSEN
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Credential | DPM
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Telephone | 419-345-7867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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