Provider Demographics
NPI:1164685640
Name:SANDHU, NAVEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:NAVEEN
Middle Name:
Last Name:SANDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 RIVERVIEW DR
Mailing Address - Street 2:STE A
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-8908
Mailing Address - Country:US
Mailing Address - Phone:601-981-1610
Mailing Address - Fax:601-366-2887
Practice Address - Street 1:102 RIVERVIEW DR
Practice Address - Street 2:STE A
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8908
Practice Address - Country:US
Practice Address - Phone:601-981-1610
Practice Address - Fax:601-366-2887
Is Sole Proprietor?:No
Enumeration Date:2008-07-06
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21575207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03159265Medicaid
MS03159265Medicaid