Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0300X | Geriatric Medicine | 35. 081392 | OH |
Y | 207RG0300X | Geriatric Medicine | 49824 | WI |
NPI | 1003882994 |
---|---|
Provider Name | Soryal A Soryal |
First Address | Milwaukee, WI 53233-1308 |
Second Address | Milwaukee, WI 53233-1308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34735800 | (05) | WI |
I17878 | (02) | OH |