Provider Demographics
NPI:1548294176
Name:SODERSTROM, ROBERT M (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:SODERSTROM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5131 W BRISTOL RD
Mailing Address - Street 2:STE A
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2970
Mailing Address - Country:US
Mailing Address - Phone:810-733-2090
Mailing Address - Fax:630-495-1770
Practice Address - Street 1:G-5131 WEST BRISTOL RD
Practice Address - Street 2:STE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507
Practice Address - Country:US
Practice Address - Phone:810-733-2090
Practice Address - Fax:810-733-0387
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2019-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301032434207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0257159OtherBLUE CARE NETWORK MICHIGA
MI0771592OtherHEALTHPLUS OF MICHIGAN
MI1421419Medicaid
MI0771592OtherHEALTHPLUS OF MICHIGAN
MIB46958Medicare UPIN