Basic Information
| Provider Information | |||||||||
| NPI: | 1932159993 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOBTI | ||||||||
| FirstName: | PREM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843225 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132628160 | ||||||||
| FaxNumber: | 8138919066 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 SAINT FRANCIS DR | ||||||||
| Address2: | SUITE 372 | ||||||||
| City: | CAPE GIRARDEAU | ||||||||
| State: | MO | ||||||||
| PostalCode: | 637035049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5733315525 | ||||||||
| FaxNumber: | 5733315534 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 03/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | 2004017430 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
ID Information
| ID | Type | State | Issuer | Description | 165777001 | 05 | AR | MEDICAID | P00302293 | 01 | RAILROAD MEDICARE | OTHER | 204491 | 01 | MO | BCBS | OTHER | 690077 | 01 | HEALTHLINK | OTHER | 6406297900 | 05 | KY | MEDICAID | 206176802 | 05 | MO | MEDICAID |