Provider Demographics
NPI:1841243680
Name:SOTELO, CARLOS A (DO)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:SOTELO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 ARBORETUM DR
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-1352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2142 N COVE BLVD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3895
Practice Address - Country:US
Practice Address - Phone:419-291-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI013218207PE0004X
OH34-008909207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4710040Medicaid
OH000000522450OtherANTHEM BCBS
MI4709880Medicaid
MICS013218OtherBLUE CROSS BLUE SHIELD
OH2776572Medicaid
MI4856160Medicaid
OH000000522463OtherANTHEM
MI4709880Medicaid
OH2776572Medicaid
OHSO4213311Medicare PIN
OHP00403160Medicare PIN
MIM60660293Medicare ID - Type Unspecified
OH000000522450OtherANTHEM BCBS
MICS013218OtherBLUE CROSS BLUE SHIELD