Healthcare Provider Details

I. General information

NPI: 1427231224
Provider Name (Legal Business Name): SORVEIN PRIETO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2113 W CHICAGO AVE
CHICAGO IL
60622-8881
US

IV. Provider business mailing address

750 PEARSON ST
DES PLAINES IL
60016-9211
US

V. Phone/Fax

Practice location:
  • Phone: 773-489-6100
  • Fax: 773-489-6156
Mailing address:
  • Phone: 773-619-0127
  • Fax: 773-489-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036118602
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: