Provider Demographics
NPI:1053303750
Name:MINHAS, SOHAIL A (MD)
Entity Type:Individual
Prefix:
First Name:SOHAIL
Middle Name:A
Last Name:MINHAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:901-227-8591
Practice Address - Street 1:7900 AIRWAYS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4113
Practice Address - Country:US
Practice Address - Phone:662-349-2442
Practice Address - Fax:662-349-8551
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE1105207RH0003X
TN29661207RH0003X
MS16334207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO206025900Medicaid
AR5L754OtherBLUE CROSS BLUE SHIELD
AR143950001Medicaid
MS00122500Medicaid
TN3843703Medicaid
0384841OtherCIGNA
5921568OtherAETNA
TN3137748OtherBLUE CROSS BLUE SHIELD
MO206025900Medicaid
5921568OtherAETNA
AR5L754OtherBLUE CROSS BLUE SHIELD
MS00122500Medicaid
0384841OtherCIGNA
MS00122500Medicaid