Provider Demographics
NPI:1346474426
Name:MALGORZATA SOBILO M D P C
Entity Type:Organization
Organization Name:MALGORZATA SOBILO M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBILO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-693-6238
Mailing Address - Street 1:720 N LAPEER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48362-4011
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:48362-4012
Practice Address - Country:US
Practice Address - Phone:248-693-6238
Practice Address - Fax:248-693-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10-5181722Medicaid
MIG13798Medicare UPIN
MIMI1713Medicare PIN