1063421840 NPI number — MICHAEL J. SORSCHER M.D.

Table of content: JEFFREY THOMAS RODGERS (NPI 1821891805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063421840 NPI number — MICHAEL J. SORSCHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORSCHER
Provider First Name:
MICHAEL
Provider Middle Name:
J.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063421840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4442 GENESYS PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND BLANC
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48439-8072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-974-2673
Provider Business Mailing Address Fax Number:
866-939-2673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4442 GENESYS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND BLANC
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48439-8072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-974-2673
Provider Business Practice Location Address Fax Number:
866-939-2673
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  4301051814 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 4301051814 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0114X , with the licence number: 4301051814 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C3578 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 38-2710423 . This is a "TAX ID EFF 1.19.15" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383566557 . This is a "FEDERAL TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 26S26606 . This is a "HEALTH PLUS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2002503071 . This is a "BLUE CROSS BLUE SHELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4261300 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200040238 . This is a "PALMETTO GBA RAILROAD MR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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