Provider Demographics
NPI:1417028523
Name:SANGHERA, PERMINDER S (MD)
Entity Type:Individual
Prefix:
First Name:PERMINDER
Middle Name:S
Last Name:SANGHERA
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 1:13350 N 94TH DR
Mailing Address - Street 2:SUITE A101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4826
Mailing Address - Country:US
Mailing Address - Phone:623-933-1010
Mailing Address - Fax:623-933-3383
Practice Address - Street 1:13350 N 94TH DR
Practice Address - Street 2:SUITE A101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4826
Practice Address - Country:US
Practice Address - Phone:623-933-1010
Practice Address - Fax:623-933-3383
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25323207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ401927Medicaid
AZG15695Medicare UPIN
AZ105510Medicare PIN