Provider Demographics
NPI:1912163502
Name:ABREU SOSA, SOL MARIAM (MD)
Entity Type:Individual
Prefix:
First Name:SOL
Middle Name:MARIAM
Last Name:ABREU SOSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 W HARRISON ST STE 118
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3817
Mailing Address - Country:US
Mailing Address - Phone:312-942-8905
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 118
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3817
Practice Address - Country:US
Practice Address - Phone:312-942-8905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-02
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036146923208100000X
PR18518208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation