Provider Demographics
NPI:1003030685
Name:SOBH, MOHAMAD A (DO, RPH)
Entity Type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:A
Last Name:SOBH
Suffix:
Gender:M
Credentials:DO, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2912
Mailing Address - Country:US
Mailing Address - Phone:313-278-7100
Mailing Address - Fax:313-562-2216
Practice Address - Street 1:1611 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2912
Practice Address - Country:US
Practice Address - Phone:313-278-7100
Practice Address - Fax:313-562-2216
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2014-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302031496183500000X
MI5101016232207RC0000X, 207R00000X, 2086S0129X, 207UN0901X, 2085U0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No183500000XPharmacy Service ProvidersPharmacist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1003030685Medicaid
MIMI2560005Medicare PIN