Provider Demographics
NPI:1912122995
Name:CAISON-SOREY, THELMA J (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:THELMA
Middle Name:J
Last Name:CAISON-SOREY
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:DR
Other - First Name:THELMA
Other - Middle Name:JANN
Other - Last Name:CAISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:HENRY FORD HEALTH SYSTEM, 1 FORD PLACE
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS, SUITE 4B,
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2608
Mailing Address - Country:US
Mailing Address - Phone:313-448-8366
Mailing Address - Fax:800-472-0118
Practice Address - Street 1:1 FORD PL
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS 4B
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3450
Practice Address - Country:US
Practice Address - Phone:313-448-8366
Practice Address - Fax:800-472-0118
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044212208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF02006Medicare UPIN
MIOH2-62289-701Medicare ID - Type Unspecified