MEDICARE: DR. PAOLO KWAN SORIANO 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	207RH0003X	Hematology & Oncology Physician	0101274954	VA
2	207RH0003X	Hematology & Oncology Physician	036-145561	IL
3	207R00000X	Internal Medicine Physician	036-145561	IL
4	207RH0003X	Hematology & Oncology Physician	2023028620	MO
5	208M00000X	Hospitalist Physician	036145561	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036-145561	OTHER	IL	STATE LICENSE

General Provider Information

NPI Number	:	1932581022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAOLO KWAN SORIANO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 505673
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63150-5673
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 N RUTLEDGE ST STE 1100
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62702-4968
Country	:	US
Telephone Number	:	217-545-8000
Fax Number	:	217-545-4735

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

Provider Enumeration Date	:	06/24/2015
Last Update Date	:	06/19/2026

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Directions to “ DR. PAOLO KWAN SORIANO M.D.” Practice Location

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