Provider Demographics
NPI:1992709323
Name:SONDERMAN, PHILIP L (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:SONDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 W NORTH AVENUE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005
Mailing Address - Country:US
Mailing Address - Phone:262-717-4000
Mailing Address - Fax:262-641-7435
Practice Address - Street 1:13800 W NORTH AVENUE
Practice Address - Street 2:SUITE 110
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-717-4000
Practice Address - Fax:262-641-7435
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28087174400000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31783900Medicaid
WI31783900Medicaid
WIF24493Medicare UPIN