Provider Demographics
NPI:1386179141
Name:SINGH, JUSTIN (DPM)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E MCKELLIPS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-9654
Mailing Address - Country:US
Mailing Address - Phone:602-491-0703
Mailing Address - Fax:480-631-0581
Practice Address - Street 1:840 E MCKELLIPS RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-9654
Practice Address - Country:US
Practice Address - Phone:602-491-0703
Practice Address - Fax:480-631-0581
Is Sole Proprietor?:No
Enumeration Date:2017-04-28
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-000989213ES0103X
OH36.003980213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ098502Medicaid