Provider Demographics
NPI:1508928763
Name:SHERMAN G SORENSEN MD
Entity Type:Organization
Organization Name:SHERMAN G SORENSEN MD
Other - Org Name:SORENSEN CARDIOVASCULAR GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-507-3656
Mailing Address - Street 1:5169 COTTONWOOD STREET
Mailing Address - Street 2:SUITE 610
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5701
Mailing Address - Country:US
Mailing Address - Phone:801-507-3656
Mailing Address - Fax:801-507-3657
Practice Address - Street 1:5169 COTTONWOOD STREET
Practice Address - Street 2:SUITE 610
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5701
Practice Address - Country:US
Practice Address - Phone:801-507-3656
Practice Address - Fax:801-507-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT168722-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTC63528Medicare UPIN
UT000059651Medicare PIN