Individual
ISMAEL HIRAM SOTO RIVAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2725 AIRVIEW BLVD STE 105, PORTAGE, MI 49002
(269) 349-8386
(269) 349-8397
Mailing address
2725 AIRVIEW BLVD STE 105, PORTAGE, MI 49002-1804
(269) 349-8386
(269) 349-8397
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
13373
PR
207Q00000X
Family Medicine Physician
Primary
4301113708
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21479 SO
TRIPLE-S
—
Enumeration date
08/12/2006
Last updated
01/30/2019
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