Provider Demographics
NPI:1912291154
Name:SOBRALSKE, MARK MICHAEL (LAC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MICHAEL
Last Name:SOBRALSKE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N5268 17TH DR
Mailing Address - Street 2:
Mailing Address - City:WILD ROSE
Mailing Address - State:WI
Mailing Address - Zip Code:54984-6220
Mailing Address - Country:US
Mailing Address - Phone:312-613-7396
Mailing Address - Fax:
Practice Address - Street 1:N5268 17TH DR
Practice Address - Street 2:
Practice Address - City:WILD ROSE
Practice Address - State:WI
Practice Address - Zip Code:54984-6220
Practice Address - Country:US
Practice Address - Phone:312-613-7396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI93355171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist