MEDICARE: CHRISTINA TAN SORIANO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-135581	IL

General Provider Information

NPI Number	:	1215215744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA TAN SORIANO MD

Provider Business Mailing Address
First Line	:	3753 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-1662
Country	:	US
Telephone Number	:	773-268-7600
Fax Number	:	833-428-3986

Provider Business Practice Location Address
First Line	:	3753 S COTTAGE GROVE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-1662
Country	:	US
Telephone Number	:	773-268-7600
Fax Number	:	833-428-3986

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2011
Last Update Date	:	02/06/2026

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