Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 01059980A | IN |
N | 204C00000X | Sports Medicine Doctor | 4301069245 | MI |
N | 207P00000X | Emergency Physician | 4301069245 | MI |
Y | 207RG0300X | Geriatric Medicine | 01059980A | IN |
N | 207RG0300X | Geriatric Medicine | 4301069245 | MI |
NPI | 1053523910 |
---|---|
Provider Name | Dr. Syed Sohail |
First Address | Fort Wayne, IN 46814-9339 |
Second Address | Fort Wayne, IN 46805-2233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 02/05/2017 |