Provider Demographics
NPI:1336669233
Name:MEDPRO INC
Entity Type:Organization
Organization Name:MEDPRO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:
Authorized Official - Last Name:TANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-751-1954
Mailing Address - Street 1:3814 CALVERHALL WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3254
Mailing Address - Country:US
Mailing Address - Phone:916-751-1954
Mailing Address - Fax:
Practice Address - Street 1:6 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3037
Practice Address - Country:US
Practice Address - Phone:916-751-1954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty