Basic Information
Provider Information
NPI: 1053305896
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SINGH
FirstName: BHUPINDER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2149 E WARNER RD
Address2: SUITE 101
City: TEMPE
State: AZ
PostalCode: 852843494
CountryCode: US
TelephoneNumber: 4806106100
FaxNumber:  
Practice Location
Address1: 2141 E WARNER RD
Address2: SUITE 101
City: TEMPE
State: AZ
PostalCode: 852843493
CountryCode: US
TelephoneNumber: 4809698714
FaxNumber: 4804640189
Other Information
ProviderEnumerationDate: 09/08/2005
LastUpdateDate: 06/19/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X30019AZY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

ID Information
IDTypeStateIssuerDescription
64366005AZ MEDICAID
Z14732401AZBANNER MD ANDERSON CANCER CENTEROTHER


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