Basic Information
| Provider Information | |||||||||
| NPI: | 1700415452 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOOD | ||||||||
| FirstName: | ANEIL | ||||||||
| MiddleName: | ANDREW JAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10559 CHATHAM CT | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460328301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3173061684 | ||||||||
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| Practice Location | |||||||||
| Address1: | 525 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443041619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303753648 | ||||||||
| FaxNumber: | 3303753751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2020 | ||||||||
| LastUpdateDate: | 04/05/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.