MEDICARE: CHRISTOPHER T SOPRENUK 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	207RH0003X	Hematology & Oncology Physician	ME #50490	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00073542	OTHER	FL	RAILROAD MEDICARE

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
3	04430	OTHER	FL	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1962499111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER T SOPRENUK MD

Provider Business Mailing Address
First Line	:	9846 US HIGHWAY 441
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34788-3910
Country	:	US
Telephone Number	:	352-728-1886
Fax Number	:	352-728-1024

Provider Business Practice Location Address
First Line	:	9846 US HIGHWAY 441
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34788-3910
Country	:	US
Telephone Number	:	352-728-1886
Fax Number	:	352-728-1024

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

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	07/29/2007

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Directions to “ CHRISTOPHER T SOPRENUK MD” Practice Location

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