Basic Information
| Provider Information | |||||||||
| NPI: | 1013292622 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAHAL | ||||||||
| FirstName: | KHUSHDEEP | ||||||||
| MiddleName: | SINGH | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10005 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356312005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567689509 | ||||||||
| FaxNumber: | 2567689715 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 MARENGO STREET | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567689509 | ||||||||
| FaxNumber: | 2567689715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2011 | ||||||||
| LastUpdateDate: | 03/02/2018 | ||||||||
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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 | 207R00000X | MD.33511 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 33511 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 206544 | 05 | AL | MEDICAID |