Provider Demographics
NPI:1487848578
Name:SORIANO, EDWIN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:PATRICK
Last Name:SORIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12903 CANOPY WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5099
Mailing Address - Country:US
Mailing Address - Phone:773-368-3972
Mailing Address - Fax:
Practice Address - Street 1:12903 CANOPY WOODS WAY
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5099
Practice Address - Country:US
Practice Address - Phone:773-368-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036119056Medicaid
IL0163557OtherBLUE CROSS
FL015985600Medicaid
IL036119056Medicaid
IL0163557OtherBLUE CROSS
FL015985600Medicaid
IL211056007Medicare PIN