MEDICARE: MR. DENNIS MICHAEL SOSENKO PA-C

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1992765101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS MICHAEL SOSENKO PA-C

Provider Business Mailing Address
First Line	:	1215 ANDERSON DR
Second Line	:
City	:	LEESVILLE
State	:	LA
Zip	:	71446-3721
Country	:	US
Telephone Number	:	337-239-7657
Fax Number	:

Provider Business Practice Location Address
First Line	:	USAMEDDAC
Second Line	:	1585 3RD ST
City	:	FORT POLK
State	:	LA
Zip	:	71459-5110
Country	:	US
Telephone Number	:	337-531-3529
Fax Number	:

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/08/2007

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