Provider Demographics
NPI:1063682466
Name:SODETZ, RICHARD A (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:SODETZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5329 DUGAN LAKE ROAD
Mailing Address - Street 2:PO BOX 297
Mailing Address - City:STONE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54876-0297
Mailing Address - Country:US
Mailing Address - Phone:715-865-5002
Mailing Address - Fax:
Practice Address - Street 1:641 S ASHLAND AVE
Practice Address - Street 2:UNIT J
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3167
Practice Address - Country:US
Practice Address - Phone:715-865-5002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery