Provider Demographics
NPI:1417184243
Name:KIRMANI MOE, SOBIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOBIA
Middle Name:
Last Name:KIRMANI MOE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6302 ODANA RD
Mailing Address - Street 2:302
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-1162
Mailing Address - Country:US
Mailing Address - Phone:608-293-2759
Mailing Address - Fax:608-646-6768
Practice Address - Street 1:6302 ODANA RD
Practice Address - Street 2:302
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1162
Practice Address - Country:US
Practice Address - Phone:608-293-2759
Practice Address - Fax:608-646-6768
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI57589202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry