MEDICARE: SORYAL A SORYAL M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	49824	WI
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	35. 081392	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003882994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SORYAL A SORYAL M.D

Provider Business Mailing Address
First Line	:	1020 N 12TH ST
Second Line	:	3RD FLOOR
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-1308
Country	:	US
Telephone Number	:	414-219-7300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 N 12TH ST
Second Line	:	3RD FLOOR
City	:	MILWAUKEE
State	:	WI
Zip	:	53233-1308
Country	:	US
Telephone Number	:	414-219-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	11/23/2021

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