Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 4301029937 | MI |
NPI | 1003856410 |
---|---|
Provider Name | Dr. Freddy R Sosa |
First Address | Southfield, MI 48075-4825 |
Second Address | Southfield, MI 48075-4825 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 22/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0638265 | BLUE CARE NETWORK (01) | |
0638265 | MEDICARE (01) | MI |
104308845 | (05) | MI |
1051407 | (05) | MI |
110638265 | BCBS (01) | |
110Q262840 | BCBSM/BCN (01) | MI |
1S0638265 | HEALTH PLUS PPO (01) | MI |
2437498 | CIGNA (01) | MI |
5133233 | AETNA (01) | MI |
B45138 | (02) | MI |
B45138 | HAP (01) | MI |