MEDICARE: DR. MILTON D SODERBERG 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	207N00000X	Dermatology Physician	4301026190	MI

General Provider Information

NPI Number	:	1255446506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MILTON D SODERBERG MD

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-684-1439

Provider Business Practice Location Address
First Line	:	1414 W FAIR AVE STE 240
Second Line	:
City	:	MARQUETTE
State	:	MI
Zip	:	49855-5409
Country	:	US
Telephone Number	:	906-225-3939
Fax Number	:	906-225-7488

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	02/24/2021

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