Healthcare Provider Details

I. General information

NPI: 1053523910
Provider Name (Legal Business Name): SYED SOHAIL M.D.MPH.MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SYED SOHAIL M.D. MBA.,MPH

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 N ANTHONY BLVD SUITE 2
FORT WAYNE IN
46805-2233
US

IV. Provider business mailing address

1331 SYCAMORE HILLS PKWY
FORT WAYNE IN
46814-9339
US

V. Phone/Fax

Practice location:
  • Phone: 260-471-5777
  • Fax: 260-480-2689
Mailing address:
  • Phone: 260-249-9779
  • Fax: 260-625-5924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number01059980A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301069245
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number01059980A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number01059980A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number01059980A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number4301069245
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number4301069245
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number4301069245
License Number StateMI
# 9
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number4301069245
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: