Provider Demographics
NPI:1962480731
Name:SOSA, JULIO M (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:M
Last Name:SOSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5641 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3714
Mailing Address - Country:US
Mailing Address - Phone:248-538-3020
Mailing Address - Fax:248-538-0892
Practice Address - Street 1:5641 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-538-3020
Practice Address - Fax:248-538-0892
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061683208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4099870Medicaid
G95869Medicare UPIN
0M82810Medicare ID - Type Unspecified