MEDICARE: DR. MITCHELL IAN SORSBY M.D.

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
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	J6248	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4652115	OTHER	TX	AETNA
2	841566	OTHER	TX	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154375939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITCHELL IAN SORSBY M.D.

Provider Business Mailing Address
First Line	:	1820 PRESTON PARK BLVD
Second Line	:	STE 1850
City	:	PLANO
State	:	TX
Zip	:	75093-3633
Country	:	US
Telephone Number	:	972-867-4658
Fax Number	:	972-867-8696

Provider Business Practice Location Address
First Line	:	1820 PRESTON PARK BLVD
Second Line	:	SUITE 1850
City	:	PLANO
State	:	TX
Zip	:	75093-3656
Country	:	US
Telephone Number	:	972-867-4658
Fax Number	:	972-867-8696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	11/21/2016

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