MEDICARE: DR. SONJA M EARLES 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	208000000X	Pediatrics Physician	4301065586	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437157955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONJA M EARLES MD

Provider Business Mailing Address
First Line	:	PO BOX 44047
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48244-0047
Country	:	US
Telephone Number	:	248-451-0600
Fax Number	:	248-451-0700

Provider Business Practice Location Address
First Line	:	43205 WOODWARD AVE
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48302-5006
Country	:	US
Telephone Number	:	248-451-0600
Fax Number	:	248-451-0700

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	04/29/2009

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