Provider Demographics
NPI:1699758920
Name:SOHAL, CHAMAN LAL (MD)
Entity type:Individual
Prefix:
First Name:CHAMAN
Middle Name:LAL
Last Name:SOHAL
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 1:6742 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ALLEN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48101-2034
Mailing Address - Country:US
Mailing Address - Phone:313-928-2333
Mailing Address - Fax:
Practice Address - Street 1:6742 PARK AVE
Practice Address - Street 2:
Practice Address - City:ALLEN PARK
Practice Address - State:MI
Practice Address - Zip Code:48101-2034
Practice Address - Country:US
Practice Address - Phone:313-928-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301044613207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1660060Medicaid
MIOM18000004Medicare ID - Type Unspecified
MI1660060Medicaid