Healthcare Provider Details

I. General information

NPI: 1982870317
Provider Name (Legal Business Name): LUDA MILA SORIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9330
  • Fax:
Mailing address:
  • Phone: 847-318-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number036133594
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number2023-03258
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number036.133594
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: