Provider Demographics
NPI:1962068163
Name:SOURESHO, HELDA (MD)
Entity type:Individual
Prefix:
First Name:HELDA
Middle Name:
Last Name:SOURESHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1009
Mailing Address - Country:US
Mailing Address - Phone:810-648-3770
Mailing Address - Fax:
Practice Address - Street 1:109 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1008
Practice Address - Country:US
Practice Address - Phone:810-648-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301505947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine