Provider Demographics
NPI:1013065556
Name:SORUCO, LUIS FERNANDO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:FERNANDO
Last Name:SORUCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:FERNANDO
Other - Last Name:SORUCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2101 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:111
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4185
Mailing Address - Country:US
Mailing Address - Phone:847-228-3200
Mailing Address - Fax:847-228-3740
Practice Address - Street 1:2101 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:111
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4185
Practice Address - Country:US
Practice Address - Phone:847-228-3200
Practice Address - Fax:847-228-3740
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036060323207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43751Medicare UPIN
ILP11081Medicare ID - Type UnspecifiedMEDICARE ID NUMBER