Provider Demographics
NPI:1699084533
Name:SORIANO, HAIDI
Entity type:Individual
Prefix:MS
First Name:HAIDI
Middle Name:
Last Name:SORIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 DEMPSTER ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1802
Mailing Address - Country:US
Mailing Address - Phone:847-414-0291
Mailing Address - Fax:
Practice Address - Street 1:5139 DEMPSTER ST
Practice Address - Street 2:UNIT A
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1802
Practice Address - Country:US
Practice Address - Phone:847-414-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070011421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL273348633OtherBCBS OF ILLINOIS
IL273348633Medicaid
IL273348633OtherBCBS OF ILLINOIS