Provider Demographics
NPI:1700077054
Name:SOFORO, EKATERINA V (MD)
Entity type:Individual
Prefix:
First Name:EKATERINA
Middle Name:V
Last Name:SOFORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 N TAYLOR DR STE 110
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-3090
Mailing Address - Country:US
Mailing Address - Phone:920-320-5241
Mailing Address - Fax:
Practice Address - Street 1:1414 N TAYLOR DR STE 110
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3090
Practice Address - Country:US
Practice Address - Phone:920-320-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52056-20207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI207R00000XMedicaid
WIP00976931OtherRR MEDICARE
WI207R00000XMedicaid
WI520107Medicare Oscar/Certification