Provider Demographics
NPI:1225130008
Name:SINGH, SUDEEP (MD)
Entity Type:Individual
Prefix:
First Name:SUDEEP
Middle Name:
Last Name:SINGH
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 1:8839 N CEDAR
Mailing Address - Street 2:# 53
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-431-9571
Mailing Address - Fax:559-431-4721
Practice Address - Street 1:7011 N HOWARD
Practice Address - Street 2:#201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-431-9571
Practice Address - Fax:559-431-4721
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A491470207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084990Medicaid
CA00A491470Medicare ID - Type Unspecified
CAGR0084990Medicaid