Physician Compare National (NPI:1710986047)

HEALTHCARE PROVIDER: KEVIN COURTNEY SORENSEN DPM

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1710986047
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5092780593
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20160425000047
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SORENSEN
	Individual professional last name
Provider First Name	KEVIN
	Individual professional first name
Provider Middle Name	COURTNEY
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DPM
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2002
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	44000 W 12 MILE RD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 111
	Group Practice or individual's line 2 address
City	NOVI
	Group Practice or individual's city
State	MI
	Group Practice or individual's state
Zip Code	483772646
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	230019
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROVIDENCE HOSP AND MED CTRS
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y