Provider Demographics
NPI:1194711010
Name:SORTINO, JOHN M (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:SORTINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 SE MIZNER BOULEVARD
Mailing Address - Street 2:SUITE 10
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-5007
Mailing Address - Country:US
Mailing Address - Phone:561-391-8343
Mailing Address - Fax:561-391-8294
Practice Address - Street 1:113 SE MIZNER BOULEVARD
Practice Address - Street 2:SUITE 10
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-5007
Practice Address - Country:US
Practice Address - Phone:561-391-8343
Practice Address - Fax:561-391-8294
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53109207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD21176Medicare UPIN
FL07210ZMedicare PIN