Provider Demographics
NPI:1902883671
Name:SORE, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:SORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8405
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33674-8405
Mailing Address - Country:US
Mailing Address - Phone:813-220-7594
Mailing Address - Fax:
Practice Address - Street 1:4004 N RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3212
Practice Address - Country:US
Practice Address - Phone:813-296-8300
Practice Address - Fax:813-441-7669
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85141207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34204200Medicaid
WI0054Medicare ID - Type Unspecified
WI34204200Medicaid