Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 46195 | CO |
Y | 207RG0300X | Geriatric Medicine | 64303-20 | WI |
NPI | 1073702627 |
---|---|
Provider Name | Lubna Tayyab Sorathia |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2007 |
Last Update Date | 14/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
92720234 | (05) | CO |