Provider Demographics
NPI:1437322823
Name:SAULOG, SOLFIA MEDINA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SOLFIA
Middle Name:MEDINA
Last Name:SAULOG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SOLFIA
Other - Middle Name:MEDINA
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4075 COPPER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7059
Mailing Address - Country:US
Mailing Address - Phone:888-632-0543
Mailing Address - Fax:231-932-4204
Practice Address - Street 1:1800 E LAKE SHORE DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3810
Practice Address - Country:US
Practice Address - Phone:217-464-2870
Practice Address - Fax:217-464-1616
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice