Provider Demographics
NPI:1275164964
Name:SOKOL, DOUGLAS MICHAEL (LPN)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:SOKOL
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10077 HORTON RD
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9088
Mailing Address - Country:US
Mailing Address - Phone:248-904-5596
Mailing Address - Fax:
Practice Address - Street 1:4443 MILLER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-1123
Practice Address - Country:US
Practice Address - Phone:810-733-1185
Practice Address - Fax:810-733-5897
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-31
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703108043164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty