Basic Information
| Provider Information | |||||||||
| NPI: | 1154563203 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHILLON | ||||||||
| FirstName: | VARINDER | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7590 AUBURN ROAD, SUITE 014 | ||||||||
| Address2: | ATTN: MED STAFF | ||||||||
| City: | CONCORD TWP. | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440779176 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4403541899 | ||||||||
| FaxNumber: | 4403541845 | ||||||||
| Practice Location | |||||||||
| Address1: | 2747 SOM CENTER RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | WILLOUGHBY HILLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440949164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405160530 | ||||||||
| FaxNumber: | 4405160492 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2009 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35-0969572 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3149006 | 05 | OH | MEDICAID |