Provider Demographics
NPI:1780726836
Name:SOBHAN, TANVEER (MD)
Entity type:Individual
Prefix:
First Name:TANVEER
Middle Name:
Last Name:SOBHAN
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 1:1065 NE 125TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5833
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:305-891-4228
Practice Address - Street 1:7481 W OAKLAND PARK BLVD STE 100
Practice Address - Street 2:STE 100
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-4985
Practice Address - Country:US
Practice Address - Phone:954-771-7743
Practice Address - Fax:954-771-7748
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00653792084P0800X
FLME982392084P0800X, 2084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279204400Medicaid
D02716OtherFRHS BCBS
240748OtherFRHS MIDLANDS CHOICE
240748OtherFRHS MIDLANDS CHOICE
D02716OtherFRHS BCBS
NE47079687527Medicaid
276923Medicare ID - Type UnspecifiedFRHS INDIVIDUAL
NEBS7943067OtherDEA NORFOLK NE
FL279204400Medicaid