Provider Demographics
NPI:1194782037
Name:SORIN, JOHN P (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:SORIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:201 E HURON ST
Mailing Address - Street 2:SUITE 12-160
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-695-1700
Mailing Address - Fax:312-695-1777
Practice Address - Street 1:201 E HURON ST
Practice Address - Street 2:SUITE 12-160
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3197
Practice Address - Country:US
Practice Address - Phone:312-695-1700
Practice Address - Fax:312-695-1777
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2015-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036056176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056176Medicaid
IL036056176Medicaid
IL658050Medicare ID - Type Unspecified