Provider Demographics
NPI:1700864295
Name:SORIA, LOREN L (MD)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:L
Last Name:SORIA
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 1:600 N COLLEGE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GENESEO
Mailing Address - State:IL
Mailing Address - Zip Code:61254-1091
Mailing Address - Country:US
Mailing Address - Phone:309-944-5342
Mailing Address - Fax:309-944-8192
Practice Address - Street 1:600 N COLLEGE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GENESEO
Practice Address - State:IL
Practice Address - Zip Code:61254-1091
Practice Address - Country:US
Practice Address - Phone:309-944-5342
Practice Address - Fax:309-944-8192
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098430207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098430Medicaid
IA1700864295Medicaid
ILP00255065OtherRR MEDICARE
ILK18232Medicare PIN
IA1700864295Medicaid