MEDICARE: IRVING MICHAEL SORSCHER DDS

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	122300000X	Dentist	2901009097	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1956314860	OTHER	MI	MEDICAL PROVIDER BLUE CRO

General Provider Information

NPI Number	:	1568537462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRVING MICHAEL SORSCHER DDS

Provider Business Mailing Address
First Line	:	6664 ORCHARD LAKE ROAD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3402
Country	:	US
Telephone Number	:	248-851-5630
Fax Number	:	248-851-5632

Provider Business Practice Location Address
First Line	:	6664 ORCHARD LAKE ROAD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3402
Country	:	US
Telephone Number	:	248-851-5630
Fax Number	:	248-851-5632

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

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/08/2007

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