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NPI Code Detail

MEDICARE: DAVID L SOVINE MD

MEDICARE: DAVID L SOVINE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician21084WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144214149
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID L SOVINE MD
Provider Business Mailing Address
First Line : 1531 S MADISON ST
Second Line :
City : APPLETON
State : WI
Zip : 54915-1800
Country : US
Telephone Number : 920-730-4411
Fax Number :
Provider Business Practice Location Address
First Line : 1531 S MADISON ST
Second Line :
City : APPLETON
State : WI
Zip : 54915-1800
Country : US
Telephone Number : 920-730-4411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 06/17/2008

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