MEDICARE: DR. ANETA SOTIROV 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
1	207Q00000X	Family Medicine Physician	4301060716	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080500206	OTHER	MI	BLUE CROSS

General Provider Information

NPI Number	:	1164492336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANETA SOTIROV MD

Provider Business Mailing Address
First Line	:	5335 AUBURN RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-4115
Country	:	US
Telephone Number	:	586-726-0011
Fax Number	:	586-726-1613

Provider Business Practice Location Address
First Line	:	5335 AUBURN RD
Second Line	:
City	:	SHELBY TOWNSHIP
State	:	MI
Zip	:	48317-4115
Country	:	US
Telephone Number	:	586-726-0011
Fax Number	:	586-726-1613

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	12/18/2013

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