Provider Demographics
NPI:1649267311
Name:SORENSEN, JOHN CHRISTIAN JR (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:SORENSEN
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18602 ROGERS PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4643
Mailing Address - Country:US
Mailing Address - Phone:210-764-1786
Mailing Address - Fax:
Practice Address - Street 1:425 HUEHL RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2319
Practice Address - Country:US
Practice Address - Phone:847-504-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP1352213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8104M6OtherBLUE CROSS BLUE SHIELD
TX081896501Medicaid
TX121550108Medicaid
TXP01571984OtherRAILROAD MEDICARE
TXF000357E7Medicaid
TX121550108Medicaid
TX451963Medicare PIN
TX451841Medicare PIN
TXF000357E7Medicaid
TXTXB134970Medicare PIN
TX451960Medicare PIN
TX451961Medicare PIN
TX081896501Medicaid
8104M6Medicare PIN
TX051962Medicare PIN
TX451838Medicare PIN