Provider Demographics
NPI:1316795263
Name:SOUDAGAR, SOHEL SHAKILAHAMED (MD)
Entity type:Individual
Prefix:MR
First Name:SOHEL
Middle Name:SHAKILAHAMED
Last Name:SOUDAGAR
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 1:2451 UNIVERSITY HOSPITAL DR. RM. 714
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36617-2293
Mailing Address - Country:US
Mailing Address - Phone:251-471-7117
Mailing Address - Fax:
Practice Address - Street 1:2451 UNIVERSITY HOSPITAL DR. RM. 714
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2293
Practice Address - Country:US
Practice Address - Phone:251-471-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ALL.6391R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program