Provider Demographics
NPI:1962499111
Name:SOPRENUK, CHRISTOPHER T (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:T
Last Name:SOPRENUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9846 US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3910
Mailing Address - Country:US
Mailing Address - Phone:352-728-1886
Mailing Address - Fax:352-728-1024
Practice Address - Street 1:9846 US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3910
Practice Address - Country:US
Practice Address - Phone:352-728-1886
Practice Address - Fax:352-728-1024
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME #50490207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258999100Medicaid
FLP00073542OtherRAILROAD MEDICARE
FL04430OtherBLUE CROSS/BLUE SHIELD
FLD 84788Medicare UPIN
FL258999100Medicaid