Provider Demographics
NPI:1225075393
Name:SOROKIN, YORAM (MD)
Entity Type:Individual
Prefix:
First Name:YORAM
Middle Name:
Last Name:SOROKIN
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 1:1420 STEPHENSON HWY
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1189
Mailing Address - Country:US
Mailing Address - Phone:248-581-5970
Mailing Address - Fax:248-581-5640
Practice Address - Street 1:3990 JOHN R
Practice Address - Street 2:7 BRUSH NORTH, BOX 163
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-993-1388
Practice Address - Fax:313-993-4100
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301054820207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
YS054820OtherCHAMPUS-CHAMPUS
MI440701010Medicaid
700H262210OtherBLUE CROSS-BLUE CROSS
YS054820OtherCOMMERCIAL-COMMERCIAL NUMBER
YS054820OtherCOMMERCIAL-COMMERCIAL NUMBER
MI440701010Medicaid
700H262210OtherBLUE CROSS-BLUE CROSS