Provider Demographics
NPI:1114898210
Name:SOREL, MAXIM VLADIMIR
Entity type:Individual
Prefix:
First Name:MAXIM
Middle Name:VLADIMIR
Last Name:SOREL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 S ANN ARBOR ST
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1303
Mailing Address - Country:US
Mailing Address - Phone:734-263-8244
Mailing Address - Fax:
Practice Address - Street 1:237 S ANN ARBOR ST
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1303
Practice Address - Country:US
Practice Address - Phone:734-263-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-13
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program