1679706774 NPI number — MS. RAVNEET KAUR DHILLON M.D

Table of content: MS. RAVNEET KAUR DHILLON M.D (NPI 1679706774)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679706774 NPI number — MS. RAVNEET KAUR DHILLON M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DHILLON
Provider First Name:
RAVNEET
Provider Middle Name:
KAUR
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREWAL
Provider Other First Name:
RAVNEET
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679706774
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9011 N MERIDIAN ST STE 225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-5365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-574-4747
Provider Business Mailing Address Fax Number:
317-574-4737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 SHERIDAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOBLESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46060-1310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-773-0363
Provider Business Practice Location Address Fax Number:
317-770-8910
Provider Enumeration Date:
08/24/2009

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: 207RN0300X , with the licence number:  01080971A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300020172 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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