Provider Demographics
NPI:1518317247
Name:SOBESKI, MICHAEL SR
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SOBESKI
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:769 GATEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ROEBUCK
Mailing Address - State:SC
Mailing Address - Zip Code:29376-3301
Mailing Address - Country:US
Mailing Address - Phone:864-809-8689
Mailing Address - Fax:
Practice Address - Street 1:1050 CAVALIER WAY
Practice Address - Street 2:
Practice Address - City:ROEBUCK
Practice Address - State:SC
Practice Address - Zip Code:29376-3364
Practice Address - Country:US
Practice Address - Phone:864-582-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist