Provider Demographics
NPI:1740262773
Name:SORIERO, OLIVE MARY (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:OLIVE
Middle Name:MARY
Last Name:SORIERO
Suffix:
Gender:F
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 NAAB RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5925
Mailing Address - Country:US
Mailing Address - Phone:317-872-6466
Mailing Address - Fax:317-872-6498
Practice Address - Street 1:8330 NAAB RD
Practice Address - Street 2:305
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5925
Practice Address - Country:US
Practice Address - Phone:317-872-6466
Practice Address - Fax:317-872-6498
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043049174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI019461OtherTRICARE
IN0678748007 PALOtherCIGNA
IN1309576OtherFIRST HEALTH
IN00000078049OtherANTHEM
IN01043049Medicare ID - Type Unspecified
IN0678748007 PALOtherCIGNA