Healthcare Provider Details

I. General information

NPI: 1598722712
Provider Name (Legal Business Name): STEVEN M SOBOL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W MCKINLEY AVE ENTA ALLERGY, HEAD & NECK INSTITUTE
DECATUR IL
62526
US

IV. Provider business mailing address

2300 N EDWARD ST GSBLL
DECATUR IL
62526-4163
US

V. Phone/Fax

Practice location:
  • Phone: 217-876-3682
  • Fax: 217-876-3345
Mailing address:
  • Phone: 217-876-2857
  • Fax: 217-876-2874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number036071697
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: