Provider Demographics
NPI:1174795843
Name:SOSNOVEC, MILAN (MD)
Entity type:Individual
Prefix:
First Name:MILAN
Middle Name:
Last Name:SOSNOVEC
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 1:12250 SW 2ND ST
Mailing Address - Street 2:SUITE #102
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2828
Mailing Address - Country:US
Mailing Address - Phone:503-292-6238
Mailing Address - Fax:503-601-0049
Practice Address - Street 1:12250 SW 2ND ST
Practice Address - Street 2:SUITE #102
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2828
Practice Address - Country:US
Practice Address - Phone:503-292-6238
Practice Address - Fax:503-601-0049
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD109282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR184747Medicaid
C93820Medicare UPIN
OR184747Medicaid