Basic Information
| Provider Information | |||||||||
| NPI: | 1922126275 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHULLAR | ||||||||
| FirstName: | KARAMJIT | ||||||||
| MiddleName: | SINGH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 708790 | ||||||||
| Address2: | |||||||||
| City: | SANDY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840708790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668692395 | ||||||||
| FaxNumber: | 8013529502 | ||||||||
| Practice Location | |||||||||
| Address1: | 155 5TH ST NE | ||||||||
| Address2: | |||||||||
| City: | BARBERTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442033332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306153000 | ||||||||
| FaxNumber: | 3306153250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 05/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 89102 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00414514 | 01 | OH | RAIL ROAD MEDICARE | OTHER | 000000515174 | 01 | OH | BCBS OHIO | OTHER | 2732485 | 05 | OH | MEDICAID |