Healthcare Provider Details

I. General information

NPI: 1780707885
Provider Name (Legal Business Name): SORVEIN PRIETO,M.D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 E NORTHWEST HWY
MOUNT PROSPECT IL
60056-3464
US

IV. Provider business mailing address

750 PEARSON ST 507
DES PLAINES IL
60016-9211
US

V. Phone/Fax

Practice location:
  • Phone: 847-342-0351
  • Fax: 847-454-1002
Mailing address:
  • Phone: 773-619-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SORVEIN PRIETO
Title or Position: FAMILY PRACTICE
Credential: MD
Phone: 773-619-0127