Provider Demographics
NPI:1265460810
Name:SOBUS, KERSTIN M (MD)
Entity Type:Individual
Prefix:
First Name:KERSTIN
Middle Name:M
Last Name:SOBUS
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 1:516 CAREW ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-2330
Mailing Address - Country:US
Mailing Address - Phone:413-787-2051
Mailing Address - Fax:413-787-2054
Practice Address - Street 1:516 CAREW ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-787-2051
Practice Address - Fax:413-787-2054
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010619592081P0010X
MA275036208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2995102Medicaid
IN200816380Medicaid
IN200816380Medicaid