Basic Information
| Provider Information | |||||||||
| NPI: | 1306291323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RANDHAWA | ||||||||
| FirstName: | SANGRAM | ||||||||
| MiddleName: | SINGH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 N. HIGLEY ROAD | ||||||||
| Address2: | ATTN: AMANDA GUMP/HOSPITALIST TEAM | ||||||||
| City: | GILBERT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805432034 | ||||||||
| FaxNumber: | 4805432647 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 E. FLORENCE BLVD. | ||||||||
| Address2: | ATTN: AMANDA GUMP/HOSPITALIST TEAM | ||||||||
| City: | CASA GRANDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805432034 | ||||||||
| FaxNumber: | 4805432647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2016 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 12/21/2016 | ||||||||
| NPIReactivationDate: | 01/11/2017 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 57674 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 57674 | AZ | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.