Basic Information
Provider Information | |||||||||
NPI: | 1063421840 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SORSCHER | ||||||||
FirstName: | MICHAEL | ||||||||
MiddleName: | J. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4442 GENESYS PKWY | ||||||||
Address2: |   | ||||||||
City: | GRAND BLANC | ||||||||
State: | MI | ||||||||
PostalCode: | 484398072 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8669742673 | ||||||||
FaxNumber: | 8669392673 | ||||||||
Practice Location | |||||||||
Address1: | 4442 GENESYS PKWY | ||||||||
Address2: |   | ||||||||
City: | GRAND BLANC | ||||||||
State: | MI | ||||||||
PostalCode: | 484398072 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8669742673 | ||||||||
FaxNumber: | 8669392673 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/07/2006 | ||||||||
LastUpdateDate: | 05/06/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/06/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4301051814 | MI | N |   | Other Service Providers | Specialist |   | 207X00000X | 4301051814 | MI | N |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   | 207XS0114X | 4301051814 | MI | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
ID Information
ID | Type | State | Issuer | Description | C3578 | 01 | MI | MCARE | OTHER | 38-2710423 | 01 | MI | TAX ID EFF 1.19.15 | OTHER | 383566557 | 01 | MI | FEDERAL TAX ID | OTHER | 26S26606 | 01 | MI | HEALTH PLUS | OTHER | 2002503071 | 01 | MI | BLUE CROSS BLUE SHELD | OTHER | 4261300 | 05 | MI |   | MEDICAID | 200040238 | 01 | MI | PALMETTO GBA RAILROAD MR | OTHER |