Provider Demographics
NPI:1386632883
Name:PUNJWANI, SOHAIL (MD)
Entity type:Individual
Prefix:
First Name:SOHAIL
Middle Name:
Last Name:PUNJWANI
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:
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?:Yes
Enumeration Date:2005-10-10
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME545042084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00430235OtherPTAN MED RAILROAD CARRIER
MD4128117 00OtherMARYLAND MEDICAID NUMBER
CO59657863Medicaid
MD4128117 00OtherMARYLAND MEDICAID NUMBER
CO59657863Medicaid
FLP00430235OtherPTAN MED RAILROAD CARRIER
FL09837WOtherMEDICARE INDIVIDUAL PTAN FOR MZ PROFESSIONAL SERVICES, INC.
MD4128117 00OtherMARYLAND MEDICAID NUMBER
FL09837YMedicare ID - Type Unspecified
FL09837Medicare PIN