Healthcare Provider Details

I. General information

NPI: 1184682015
Provider Name (Legal Business Name): SOHAIL GULZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 HOSPITAL DR
HANNIBAL MO
63401-6887
US

IV. Provider business mailing address

PO BOX 551
HANNIBAL MO
63401-0551
US

V. Phone/Fax

Practice location:
  • Phone: 573-629-3342
  • Fax: 573-629-3432
Mailing address:
  • Phone: 573-406-5888
  • Fax: 573-248-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number105488
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: