Basic Information
Provider Information | |||||||||
NPI: | 1033430640 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SOHN | ||||||||
FirstName: | RAYMOND | ||||||||
MiddleName: | SETH | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | DEPT CH 17057 | ||||||||
Address2: |   | ||||||||
City: | PALATINE | ||||||||
State: | IL | ||||||||
PostalCode: | 600557057 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9202046758 | ||||||||
FaxNumber: | 4143253770 | ||||||||
Practice Location | |||||||||
Address1: | 2124 KOHLER MEMORIAL DR STE 110 | ||||||||
Address2: |   | ||||||||
City: | SHEBOYGAN | ||||||||
State: | WI | ||||||||
PostalCode: | 530813174 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9202046758 | ||||||||
FaxNumber: | 8887200495 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/17/2010 | ||||||||
LastUpdateDate: | 12/21/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/21/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | DR.0055453 | CO | N |   | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0014X | DR.0055453 | CO | N |   | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 207L00000X | 68489 | WI | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.