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General NPI Number Information
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NPI Number | 1073702627
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Entity Type | Individual
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Provider Name | LUBNA TAYYAB SORATHIA M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 9200 W WISCONSIN AVE GERIATRICS
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-6850
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Fax | 414-805-6851
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Provider Business Mailing Address
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Address Line | 9200 W WISCONSIN AVE GERIATRICS
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City | MILWAUKEE
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State | WI
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Zip | 53226-3522
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Country | US
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Telephone | 414-805-6850
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Fax | 414-805-6851
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 46195
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 64303-20
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License Number State | WI
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