Provider Demographics
NPI:1760433080
Name:SOHI, GURBACHAN S (MD)
Entity Type:Individual
Prefix:
First Name:GURBACHAN
Middle Name:S
Last Name:SOHI
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 1:100 MALLARD CREEK RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4194
Mailing Address - Country:US
Mailing Address - Phone:502-589-7907
Mailing Address - Fax:502-589-1319
Practice Address - Street 1:100 MALLARD CREEK RD
Practice Address - Street 2:SUITE 150
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4194
Practice Address - Country:US
Practice Address - Phone:502-589-7907
Practice Address - Fax:502-589-1319
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17652207RC0000X
IN01038328207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64176522Medicaid
IN100354370Medicaid
KYK005141Medicare PIN
KY64176522Medicaid
IN100354370Medicaid
IN100354370Medicaid
IN890680AMedicare ID - Type UnspecifiedINDIANA MEDICARE
KYC66633Medicare UPIN
KY64176522Medicaid
IN100354370Medicaid
KYCB1222Medicare PIN