Basic Information
| Provider Information | |||||||||
| NPI: | 1578592754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARANJIT DHILLON, MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6707 N 19TH AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850151104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023950718 | ||||||||
| FaxNumber: | 6022778146 | ||||||||
| Practice Location | |||||||||
| Address1: | 6707 N 19TH AVE | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850151104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6023950718 | ||||||||
| FaxNumber: | 6022778146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 08/17/2010 | ||||||||
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| AuthorizedOfficialLastName: | DHILLON | ||||||||
| AuthorizedOfficialFirstName: | CHARANJIT | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6023950718 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 11273 | AZ | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 210964 | 05 | AZ | MEDICAID |