Individual
KHALID M SONBOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1406 6TH AVE N, SAINT CLOUD, MN 56303-1901
(612) 205-6900
Mailing address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2736
(320) 251-2700
(320) 656-7115
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036141429
IL
208M00000X
Hospitalist Physician
Primary
036141429
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MEDICARE GROUP PTAN
IL
Enumeration date
06/30/2014
Last updated
06/16/2021
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