Basic Information
Provider Information | |||||||||
NPI: | 1528372075 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SINGH | ||||||||
FirstName: | GURPREET | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 3300 OAKDALE AVE N | ||||||||
Address2: |   | ||||||||
City: | ROBBINSDALE | ||||||||
State: | MN | ||||||||
PostalCode: | 554222926 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7635816560 | ||||||||
FaxNumber: | 7635814771 | ||||||||
Practice Location | |||||||||
Address1: | 1 GUTHRIE DR | ||||||||
Address2: |   | ||||||||
City: | CORNING | ||||||||
State: | NY | ||||||||
PostalCode: | 148303696 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6079377451 | ||||||||
FaxNumber: | 6079377860 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/27/2010 | ||||||||
LastUpdateDate: | 03/12/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/12/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 9327 | SD | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 63195 | MN | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 259140-1 | NY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 259140 | NY | Y |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 03326450 | 05 | NY |   | MEDICAID |