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General NPI Number Information
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NPI Number | 1568889376
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Entity Type | Organization
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Legal Business Name | MA SOBH DO PLC
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 904 MASON ST
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City | DEARBORN
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State | MI
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Zip | 48124-2215
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Country | US
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Telephone | 313-586-7525
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Fax |
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Provider Business Mailing Address
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Address Line | 904 MASON ST
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City | DEARBORN
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State | MI
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Zip | 48124-2215
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Country | US
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Telephone | 313-586-7525
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMAD A SOBH
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Credential | DO
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Telephone | 313-703-8474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 5101016232
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License Number State | MI
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