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General NPI Number Information
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NPI Number | 1609692045
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Entity Type | Organization
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Legal Business Name | ICU ON DEMAND, PLLC
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 12/02/2024
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Provider Practice Location Address
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Address Line | 15 LITTLE BOOT LN
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City | WESTWOOD
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State | MA
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Zip | 02090-2648
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Country | US
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Telephone | 104-692-5292
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Fax |
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Provider Business Mailing Address
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Address Line | 15 LITTLE BOOT LN
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City | WESTWOOD
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State | MA
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Zip | 02090-2648
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KHALD SOROUR
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Credential | MD
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Telephone | 401-692-5292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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