Provider Demographics
NPI:1861929648
Name:SORGELOOS, WILLEM (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLEM
Middle Name:
Last Name:SORGELOOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 CROSS CREEK PKWY APT 335
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-4424
Mailing Address - Country:US
Mailing Address - Phone:423-367-8713
Mailing Address - Fax:
Practice Address - Street 1:34 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1318
Practice Address - Country:US
Practice Address - Phone:601-268-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MS80235213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program