Individual
KEVIN COURTNEY SORENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
44000 W 12 MILE RD, SUITE111, NOVI, MI 48377-2644
(248) 347-8233
(248) 347-8174
Mailing address
44000 W 12 MILE RD, SUITE111, NOVI, MI 48377-2644
(248) 347-8233
(248) 347-8174
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
36.003379
OH
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
5901002082
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000340879
ANTHEM
—
01
—
04618
PARAMOUNT
OH
05
—
2490193
—
OH
Enumeration date
07/19/2005
Last updated
02/28/2017
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