Provider Demographics
NPI:1568510006
Name:SORIANO, MORRIS MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:MORRIS
Middle Name:MARC
Last Name:SORIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:973 FEATHERSTONE RD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5912
Mailing Address - Country:US
Mailing Address - Phone:815-395-1991
Mailing Address - Fax:815-395-1994
Practice Address - Street 1:973 FEATHERSTONE RD
Practice Address - Street 2:SUITE 360
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5912
Practice Address - Country:US
Practice Address - Phone:815-395-1991
Practice Address - Fax:815-395-1994
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036063255207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036063255Medicaid
IL763880Medicare ID - Type Unspecified
IL036063255Medicaid