Provider Demographics
NPI:1487679486
Name:HARMANDEEP K. GILL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HARMANDEEP K. GILL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARMANDEEP
Authorized Official - Middle Name:K
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-948-4781
Mailing Address - Street 1:PO BOX 26750
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6750
Mailing Address - Country:US
Mailing Address - Phone:661-948-4781
Mailing Address - Fax:
Practice Address - Street 1:43830 N 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-948-4781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0099250Medicaid
CADB1763Medicare PIN
CAW16694AMedicare PIN