Provider Demographics
NPI:1073057311
Name:SINGH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:SINGH MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUNANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-892-6599
Mailing Address - Street 1:14153 YOSEMITE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-8060
Mailing Address - Country:US
Mailing Address - Phone:727-222-0806
Mailing Address - Fax:727-233-9737
Practice Address - Street 1:14153 YOSEMITE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-8060
Practice Address - Country:US
Practice Address - Phone:727-222-0806
Practice Address - Fax:727-233-9737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73174207N00000X
FLME797782082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6KWUHOtherFLORIDA BCBS
FLIX299AMedicare UPIN