MEDICARE: DR. SOTERO M URETA III 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	207R00000X	Internal Medicine Physician	SU070002	MI

General Provider Information

NPI Number	:	1174545271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOTERO M URETA III M. D.

Provider Business Mailing Address
First Line	:	PO BOX 629
Second Line	:	112 E JOHN STREET
City	:	LAKE CITY
State	:	MI
Zip	:	49651-0629
Country	:	US
Telephone Number	:	231-839-4359
Fax Number	:	231-839-0223

Provider Business Practice Location Address
First Line	:	112 E JOHN STREET
Second Line	:
City	:	LAKE CITY
State	:	MI
Zip	:	49651-0629
Country	:	US
Telephone Number	:	231-839-4359
Fax Number	:	231-839-0223

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	07/08/2007

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