MEDICARE: MR. SANDEEP S SOHAL MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	4301082094	MI

General Provider Information

NPI Number	:	1992833206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SANDEEP S SOHAL MD

Provider Business Mailing Address
First Line	:	2011 MIDDLEBELT ROAD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135
Country	:	US
Telephone Number	:	734-367-1205
Fax Number	:	734-367-1214

Provider Business Practice Location Address
First Line	:	2011 MIDDLEBELT RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2819
Country	:	US
Telephone Number	:	734-367-1205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	06/27/2019

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