Provider Demographics
NPI:1013060458
Name:SORIA, EMILIO (MD)
Entity Type:Individual
Prefix:
First Name:EMILIO
Middle Name:
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 1:7891 BROADWAY STE G
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5556
Mailing Address - Country:US
Mailing Address - Phone:219-756-8000
Mailing Address - Fax:219-924-7899
Practice Address - Street 1:7891 BROADWAY STE G
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5556
Practice Address - Country:US
Practice Address - Phone:219-756-8000
Practice Address - Fax:219-756-3699
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010533072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
184921OtherANTHEM
497970KMedicare ID - Type Unspecified
D75336Medicare UPIN