Basic Information
| Provider Information | |||||||||
| NPI: | 1285639377 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | UPPAL | ||||||||
| FirstName: | RENNY | ||||||||
| MiddleName: | RAVINDER-SINGH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757863040 | ||||||||
| FaxNumber: | 7757861887 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 N ARLINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895034723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7757863040 | ||||||||
| FaxNumber: | 7757885216 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 11430 | NV | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | 11430 | NV | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100507454 | 05 | NV | MEDICAID | 2235324 | 01 | NV | FIRST CARE PIN # | OTHER | 11382386 | 01 | CAQH | OTHER |