Basic Information
| Provider Information | |||||||||
| NPI: | 1639355910 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDHU | ||||||||
| FirstName: | MANMEET | ||||||||
| MiddleName: | KAUR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 PARK ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707810075 | ||||||||
| FaxNumber: | 2707810143 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 PARK ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421011784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707810075 | ||||||||
| FaxNumber: | 2707810143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2008 | ||||||||
| LastUpdateDate: | 09/01/2015 | ||||||||
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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 | 207V00000X | 45632 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 7100220330 | 05 | KY | MEDICAID |