Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 01053307 | IN |
NPI | 1013060458 |
---|---|
Provider Name | Emilio Soria |
First Address | Merrillville, IN 46410-5556 |
Second Address | Merrillville, IN 46410-5556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 15/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
184921 | ANTHEM (01) | |
D75336 | (02) |