Provider Demographics
NPI:1164492336
Name:SOTIROV, ANETA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANETA
Middle Name:
Last Name:SOTIROV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5335 AUBURN RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-4115
Mailing Address - Country:US
Mailing Address - Phone:586-726-0011
Mailing Address - Fax:586-726-1613
Practice Address - Street 1:5335 AUBURN RD
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-4115
Practice Address - Country:US
Practice Address - Phone:586-726-0011
Practice Address - Fax:586-726-1613
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060716207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI080500206OtherBLUE CROSS
MI080500206OtherBLUE CROSS
0N26880Medicare ID - Type Unspecified