Provider Demographics
NPI:1689607541
Name:SONENSHEIN, JEFFREY MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:SONENSHEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8198 BUCKELL LAKE RD.
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-9619
Mailing Address - Country:US
Mailing Address - Phone:248-321-8898
Mailing Address - Fax:248-369-8048
Practice Address - Street 1:8198 BUCKELL LAKE RD.
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-9619
Practice Address - Country:US
Practice Address - Phone:248-321-8898
Practice Address - Fax:248-369-8048
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B44028Medicare UPIN
5630080Medicare ID - Type Unspecified