Healthcare Provider Details

I. General information

NPI: 1164355293
Provider Name (Legal Business Name): OMER SOHEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30150 PLYMOUTH RD
LIVONIA MI
48150-2100
US

IV. Provider business mailing address

2701 CARPENTER ST
DETROIT MI
48212-2785
US

V. Phone/Fax

Practice location:
  • Phone: 313-528-8476
  • Fax:
Mailing address:
  • Phone: 313-327-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: