Provider Demographics
NPI:1568889376
Name:MA SOBH DO PLC
Entity Type:Organization
Organization Name:MA SOBH DO PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOBH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-703-8474
Mailing Address - Street 1:904 MASON ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2215
Mailing Address - Country:US
Mailing Address - Phone:313-586-7525
Mailing Address - Fax:
Practice Address - Street 1:904 MASON ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2215
Practice Address - Country:US
Practice Address - Phone:313-586-7525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016232207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty