Basic Information
| Provider Information | |||||||||
| NPI: | 1740314954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AHLUWALIA | ||||||||
| FirstName: | GURPAL | ||||||||
| MiddleName: | SINGH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4000 MIAMISBURG CENTERVILLE RD | ||||||||
| Address2: | STE. 230 | ||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453427615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374335309 | ||||||||
| FaxNumber: | 9374331336 | ||||||||
| Practice Location | |||||||||
| Address1: | 4000 MIAMISBURG CENTERVILLE RD | ||||||||
| Address2: | STE. 230 | ||||||||
| City: | MIAMISBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453427615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374335309 | ||||||||
| FaxNumber: | 9374331336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 11/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | A104258 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 57.007421 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 35-09-3865A | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2987460 | 05 | OH | MEDICAID |