Provider Demographics
NPI:1285836064
Name:SOHAM PULMONARY GROUP PA
Entity type:Organization
Organization Name:SOHAM PULMONARY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BIPIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BHATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-382-8877
Mailing Address - Street 1:6801 US HWY 27 N
Mailing Address - Street 2:SUITE D4
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7840
Mailing Address - Country:US
Mailing Address - Phone:863-382-8877
Mailing Address - Fax:863-382-9147
Practice Address - Street 1:6801 US HWY 27 N
Practice Address - Street 2:SUITE D4
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7840
Practice Address - Country:US
Practice Address - Phone:863-382-8877
Practice Address - Fax:863-382-9147
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOHAM PULMONARY GROUP PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-04
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0047525174400000X
FLME47525174400000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042833700Medicaid
FLK0076Medicare ID - Type Unspecified