Provider Demographics
NPI:1043233406
Name:ANGELO J SORCE MD, PLLC
Entity Type:Organization
Organization Name:ANGELO J SORCE MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SORCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-254-9500
Mailing Address - Street 1:5958 N CANTON CENTER RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187
Mailing Address - Country:US
Mailing Address - Phone:734-254-9500
Mailing Address - Fax:734-254-9567
Practice Address - Street 1:5958 N CANTON CENTER RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187
Practice Address - Country:US
Practice Address - Phone:734-254-9500
Practice Address - Fax:734-254-9567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2008274161OtherBCBS #
MI2003000582OtherBCBS #
MI2003000582OtherBCBS #
MI0P25700Medicare ID - Type Unspecified
MI=========OtherTAX ID