Healthcare Provider Details

I. General information

NPI: 1699758920
Provider Name (Legal Business Name): CHAMAN LAL SOHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6742 PARK AVE
ALLEN PARK MI
48101-2034
US

IV. Provider business mailing address

6742 PARK AVE
ALLEN PARK MI
48101-2034
US

V. Phone/Fax

Practice location:
  • Phone: 313-928-2333
  • Fax:
Mailing address:
  • Phone: 313-928-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number4301044613
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: