Provider Demographics
NPI:1427231224
Name:PRIETO, SORVEIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SORVEIN
Middle Name:
Last Name:PRIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 PEARSON ST
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-9211
Mailing Address - Country:US
Mailing Address - Phone:773-619-0127
Mailing Address - Fax:773-489-6156
Practice Address - Street 1:2113 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-8881
Practice Address - Country:US
Practice Address - Phone:773-489-6100
Practice Address - Fax:773-489-6156
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine