Basic Information
| Provider Information | |||||||||
| NPI: | 1215135462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDHU | ||||||||
| FirstName: | HARPREET | ||||||||
| MiddleName: | KAUR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JOHL | ||||||||
| OtherFirstName: | HARPREET | ||||||||
| OtherMiddleName: | KAUR | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2940 N LITCHFIELD RD | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853957830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235350050 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2940 N LITCHFIELD RD | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853957830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235350050 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2007 | ||||||||
| LastUpdateDate: | 06/27/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | LL1754 | NV | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2084N0400X | 47079 | AZ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | LL1754 | 01 | NV | NV MEDICAL LIC | OTHER | 791429 | 05 | AZ | MEDICAID |