Provider Demographics
NPI:1053523910
Name:SOHAIL, SYED (MDMPHMBA)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:
Last Name:SOHAIL
Suffix:
Gender:M
Credentials:MDMPHMBA
Other - Prefix:
Other - First Name:SYED
Other - Middle Name:
Other - Last Name:SOHAIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD MBA,MPH
Mailing Address - Street 1:1331 SYCAMORE HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46814-9339
Mailing Address - Country:US
Mailing Address - Phone:260-249-9779
Mailing Address - Fax:260-625-5924
Practice Address - Street 1:3411 N ANTHONY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-2233
Practice Address - Country:US
Practice Address - Phone:260-471-5777
Practice Address - Fax:260-480-2689
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059980A202C00000X, 2083X0100X, 207RG0300X, 204C00000X
MI4301069245207P00000X, 202C00000X, 207RG0300X, 2083X0100X, 204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine