Individual
MARINA SODAGAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
3400 MARKET LN STE 300, KENOSHA, WI 53144-3430
(262) 551-4600
(262) 551-4630
Mailing address
3400 MARKET LN STE 300, KENOSHA, WI 53144-3430
(262) 551-4600
(262) 551-4630
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4855
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
—
Enumeration date
11/29/2010
Last updated
01/30/2024
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