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NPI Code Detail

MEDICARE: JOHN A SOBOLEWSKI MD

MEDICARE: JOHN A SOBOLEWSKI 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
1208D00000XGeneral Practice Physician01036528AIN

Other Identifiers

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

General Provider Information

NPI Number : 1912992629
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN A SOBOLEWSKI MD
Provider Business Mailing Address
First Line : PO BOX 1430
Second Line :
City : PORTAGE
State : IN
Zip : 46368-9230
Country : US
Telephone Number : 219-763-8112
Fax Number : 219-764-3251
Provider Business Practice Location Address
First Line : 2490 CENTRAL AVE
Second Line :
City : LAKE STATION
State : IN
Zip : 46405-2122
Country : US
Telephone Number : 219-763-8112
Fax Number : 219-764-3251
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 01/25/2018

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