Provider Demographics
NPI:1306043823
Name:SANDHU, MONIQUE KAUR (MD)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:KAUR
Last Name:SANDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4969 CENTRE POINTE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-6952
Mailing Address - Country:US
Mailing Address - Phone:843-853-0250
Mailing Address - Fax:
Practice Address - Street 1:4969 CENTRE POINTE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-6952
Practice Address - Country:US
Practice Address - Phone:843-853-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29963207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPENDINGMedicaid
SCSC51864251Medicare PIN