Provider Demographics
NPI:1063575108
Name:DAVID F SONEGO MD PC & ASSOCIATES
Entity type:Organization
Organization Name:DAVID F SONEGO MD PC & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:SONEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-271-8222
Mailing Address - Street 1:230 E DAY RD STE 160
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3463
Mailing Address - Country:US
Mailing Address - Phone:574-271-8222
Mailing Address - Fax:574-271-8896
Practice Address - Street 1:230 E DAY RD
Practice Address - Street 2:STE 160
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3463
Practice Address - Country:US
Practice Address - Phone:574-271-8222
Practice Address - Fax:574-271-8896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ01038008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN235300Medicare PIN