MEDICARE: ICU ON DEMAND, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207P00000X	Emergency Medicine Physician
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
3	207LC0200X	Critical Care Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1609692045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICU ON DEMAND, PLLC

Provider Business Mailing Address
First Line	:	15 LITTLE BOOT LN
Second Line	:
City	:	WESTWOOD
State	:	MA
Zip	:	02090-2648
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 LITTLE BOOT LN
Second Line	:
City	:	WESTWOOD
State	:	MA
Zip	:	02090-2648
Country	:	US
Telephone Number	:	104-692-5292
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KHALD SOROUR
Credential	:	MD
Telephone Number	:	401-692-5292

Provider Enumeration Date	:	12/02/2024
Last Update Date	:	12/02/2024

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Directions to “ICU ON DEMAND, PLLC ” Practice Location

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