Basic Information
| Provider Information | |||||||||
| NPI: | 1043484421 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROBERT M SODERSTROM MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | G5131 W BRISTOL RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107332090 | ||||||||
| FaxNumber: | 8107330387 | ||||||||
| Practice Location | |||||||||
| Address1: | G5131 W BRISTOL RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107332090 | ||||||||
| FaxNumber: | 8107330387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2008 | ||||||||
| LastUpdateDate: | 09/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | SODERSTROM | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8107332090 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | RS032434 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.