MEDICARE: JONATHAN R. SORELLE, MD., PLLC

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	207XS0106X	Orthopaedic Hand Surgery Physician	12562	NV

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	:	1134418577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JONATHAN R. SORELLE, MD., PLLC

Provider Business Mailing Address
First Line	:	PO BOX 160036
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32716-0036
Country	:	US
Telephone Number	:	702-739-4263
Fax Number	:	877-739-3590

Provider Business Practice Location Address
First Line	:	9080 W POST RD
Second Line	:	SUITE 200
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2419
Country	:	US
Telephone Number	:	702-739-4263
Fax Number	:	877-739-3590

Authorized Official
Title or Position	:	OWNER
Name	:	JONATHAN SORELLE
Credential	:	MD
Telephone Number	:	702-739-4263

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	07/22/2024

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