MEDICARE: SORIA NEUROLOGY AND SLEEP CARE LLC

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	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	01053307A	IN

General Provider Information

NPI Number	:	1487970802
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SORIA NEUROLOGY AND SLEEP CARE LLC

Provider Business Mailing Address
First Line	:	10176 W 400 N
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10176 W 400 N
Second Line	:
City	:	MICHIGAN CITY
State	:	IN
Zip	:	46360-9008
Country	:	US
Telephone Number	:	219-878-5864
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EMILIO D SORIA
Credential	:	MD
Telephone Number	:	219-476-0352

Provider Enumeration Date	:	04/09/2010
Last Update Date	:	04/09/2010

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