Individual
MICHAEL DEAN SORENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
212 SMITH CHURCH RD, ROANOKE RAPIDS, NC 27870-4914
(252) 537-1717
(252) 537-1366
Mailing address
2234 COLONIAL BLVD, ATTN: PAYER CONTRACTING AND RELATIONS, FORT MYERS, FL 33907-1412
(239) 931-7342
(239) 931-7385
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
9801068
NC
2085R0001X
Radiation Oncology Physician
C1-0006356
DE
2085R0001X
Radiation Oncology Physician
D0057941
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001154001
—
DE
05
—
1720022742
—
NC
05
—
300402300
—
MD
01
—
920006532
RAILROAD MEDICARE
DE
Enumeration date
06/16/2006
Last updated
09/08/2014
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