Provider Demographics
NPI:1376506279
Name:SORRENTINO, MARK VINCENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:VINCENT
Last Name:SORRENTINO
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:2222 PHILADELPHIA ST.
Mailing Address - Street 2:AMES FOOT CLINIC
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8700
Mailing Address - Country:US
Mailing Address - Phone:515-663-0900
Mailing Address - Fax:515-663-0905
Practice Address - Street 1:2222 PHILADELPHIA ST.
Practice Address - Street 2:AMES FOOT CLINIC
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8700
Practice Address - Country:US
Practice Address - Phone:515-663-0900
Practice Address - Fax:515-663-0905
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-06-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA00623213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI11154Medicare PIN
IAU18475Medicare UPIN