Provider Demographics
NPI:1326013293
Name:SOBILO, MALGORZATA (MD)
Entity Type:Individual
Prefix:MRS
First Name:MALGORZATA
Middle Name:
Last Name:SOBILO
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 1:785 N LAPEER RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362
Mailing Address - Country:US
Mailing Address - Phone:248-693-6238
Mailing Address - Fax:248-693-7649
Practice Address - Street 1:785 N LAPEER RD
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362
Practice Address - Country:US
Practice Address - Phone:248-693-6238
Practice Address - Fax:248-693-7649
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301059551207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0633924OtherBCBS
MI0N36500Medicare ID - Type Unspecified
MI0633924OtherBCBS