Provider Demographics
NPI:1164517439
Name:SOBAT, WILLIAM S (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:SOBAT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 RONALD REAGAN PKWY
Mailing Address - Street 2:SUITE #B-1540
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7085
Mailing Address - Country:US
Mailing Address - Phone:317-217-3675
Mailing Address - Fax:317-217-2559
Practice Address - Street 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:SUITE #B-1540
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-217-3675
Practice Address - Fax:317-217-2559
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-10-23
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Provider Licenses
StateLicense IDTaxonomies
IN01019828208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB27991Medicare UPIN
IN563570BMedicare PIN