Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 036060323 | IL |
NPI | 1013065556 |
---|---|
Provider Name | Dr. Luis Fernando Soruco |
First Address | Arlington Heights, IL 60005-4185 |
Second Address | Arlington Heights, IL 60005-4185 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 11/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C43751 | (02) | IL |