Provider Demographics
NPI:1083645345
Name:SONNEKALB, MICHAEL PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PAUL
Last Name:SONNEKALB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:3732 CARMAN RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12303-5422
Practice Address - Country:US
Practice Address - Phone:518-356-4132
Practice Address - Fax:518-355-3996
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150515208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00831690Medicaid
NY10001943OtherCDPHP
NY200136OtherSENIOR WHOLE HEALTH
NY7558570OtherAETNA
NY000401177001OtherBSNENY
NY070124000055OtherFIDELIS
NY11534OtherGHI/HMO
NY545181OtherEMPIRE BC
NY26136OtherMVP
NY070124000055OtherFIDELIS
NY26136OtherMVP