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General NPI Number Information
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NPI Number | 1740262773
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Entity Type | Individual
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Provider Name | OLIVE MARY SORIERO M.D.,PH.D
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Gender | Female
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Dates
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Enumeration Date | 11/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8330 NAAB RD 305
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-5925
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Country | US
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Telephone | 317-872-6466
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Fax | 317-872-6498
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Provider Business Mailing Address
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Address Line | 8330 NAAB RD SUITE 305
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-5925
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Country | US
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Telephone | 317-872-6466
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Fax | 317-872-6498
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 01043049
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License Number State | IN
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