Provider Demographics
NPI:1982062154
Name:SOBOTA, JOSEPH (M D)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:SOBOTA
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4253
Mailing Address - Street 2:
Mailing Address - City:HARBOR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49740-4253
Mailing Address - Country:US
Mailing Address - Phone:269-567-0240
Mailing Address - Fax:
Practice Address - Street 1:2339 PENNSYLVANIA AVE.
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-4253
Practice Address - Country:US
Practice Address - Phone:269-567-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301028352208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice