Provider Demographics
NPI:1003856410
Name:SOSA, FREDDY R (MD)
Entity type:Individual
Prefix:DR
First Name:FREDDY
Middle Name:R
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 1:22250 PROVIDENCE DR
Mailing Address - Street 2:SUITE 703
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-4825
Mailing Address - Country:US
Mailing Address - Phone:248-569-1770
Mailing Address - Fax:248-443-2439
Practice Address - Street 1:22250 PROVIDENCE DR
Practice Address - Street 2:SUITE 703
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-4825
Practice Address - Country:US
Practice Address - Phone:248-569-1770
Practice Address - Fax:248-443-2439
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301029937207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1051407Medicaid
MIB45138OtherHAP
MI104308845Medicaid
MI1S0638265OtherHEALTH PLUS PPO
MI5133233OtherAETNA
110638265OtherBCBS
0638265OtherBLUE CARE NETWORK
MI2437498OtherCIGNA
MI0638265OtherMEDICARE
MI110Q262840OtherBCBSM/BCN
MI104308845Medicaid
MI104308845Medicaid