Provider Demographics
NPI:1285044107
Name:SOPHIE, RAAFAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RAAFAY
Middle Name:
Last Name:SOPHIE
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 1:9400 S SAGINAW RD
Mailing Address - Street 2:STE D
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9666
Mailing Address - Country:US
Mailing Address - Phone:810-487-4500
Mailing Address - Fax:
Practice Address - Street 1:9400 S SAGINAW RD STE D
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-9666
Practice Address - Country:US
Practice Address - Phone:810-487-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301501258207W00000X
WI68700-20207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1285044107Medicaid