Provider Demographics
NPI:1326028135
Name:SOLER-VALCOURT, EDWIN JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:JOSE
Last Name:SOLER-VALCOURT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:EDWIN
Other - Middle Name:JOSE
Other - Last Name:SOLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:20927 KELLY RD
Mailing Address - Street 2:
Mailing Address - City:EASTPOINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48021-3128
Mailing Address - Country:US
Mailing Address - Phone:586-777-8801
Mailing Address - Fax:586-777-9988
Practice Address - Street 1:20927 KELLY RD
Practice Address - Street 2:
Practice Address - City:EASTPOINTE
Practice Address - State:MI
Practice Address - Zip Code:48021-3128
Practice Address - Country:US
Practice Address - Phone:586-777-8801
Practice Address - Fax:586-777-9988
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301068676208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4676117Medicaid
MI4676117Medicaid
MI0N67850-002Medicare ID - Type Unspecified