Provider Demographics
NPI:1619188737
Name:DHAR, SORABH (MD)
Entity Type:Individual
Prefix:
First Name:SORABH
Middle Name:
Last Name:DHAR
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 1:1560 E MAPLE ROAD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1135
Mailing Address - Country:US
Mailing Address - Phone:313-745-4525
Mailing Address - Fax:313-577-3223
Practice Address - Street 1:3901 CHRYSLER DR
Practice Address - Street 2:SUITE 4A
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2167
Practice Address - Country:US
Practice Address - Phone:313-745-4525
Practice Address - Fax:313-577-3223
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093149207R00000X, 207RI0200X
OH35084079207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2732574Medicaid
MI0P30630554Medicare PIN
OHI73175Medicare UPIN
OHDH7370251Medicare PIN