1437257961 NPI number — KARNAIL S DHILLON MD

Table of content: KARNAIL S DHILLON MD (NPI 1437257961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437257961 NPI number — KARNAIL S DHILLON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DHILLON
Provider First Name:
KARNAIL
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437257961
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 E INDIAN SCHOOL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85014-4810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-603-1440
Provider Business Mailing Address Fax Number:
602-603-1439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E INDIAN SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85014-4810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-603-1440
Provider Business Practice Location Address Fax Number:
602-603-1439
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  27921 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 203230 . This is a "VALUE OPTIONS RBHA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5637850 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: AZ0788830 . This is a "BCBS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 560864 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".