Provider Demographics
NPI:1215982269
Name:SOSALE BERKUCHEL MD
Entity type:Organization
Organization Name:SOSALE BERKUCHEL MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOSALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKUCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-648-4733
Mailing Address - Street 1:3061 CHRISTY WAY
Mailing Address - Street 2:C.O PRO MED BILLING
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-2267
Mailing Address - Country:US
Mailing Address - Phone:989-791-2433
Mailing Address - Fax:
Practice Address - Street 1:44 S MORSE ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1331
Practice Address - Country:US
Practice Address - Phone:810-648-4405
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301042585208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1930353Medicaid
MI1930353Medicaid
MI0730890Medicare PIN