MEDICARE: VICTOR SOBOLEWSKI III DO

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	60712260	WA

General Provider Information

NPI Number	:	1336158179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR SOBOLEWSKI III DO

Provider Business Mailing Address
First Line	:	PO BOX 98886
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98496-8886
Country	:	US
Telephone Number	:	253-584-3577
Fax Number	:	253-584-8916

Provider Business Practice Location Address
First Line	:	4901 108TH ST SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-3724
Country	:	US
Telephone Number	:	253-589-6484
Fax Number	:	253-984-1079

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

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	02/08/2019

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