Provider Demographics
NPI:1497951974
Name:PARDEEP S. BHULLAR MD, INC
Entity Type:Organization
Organization Name:PARDEEP S. BHULLAR MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:PARDEEP
Authorized Official - Middle Name:S
Authorized Official - Last Name:BHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-696-8046
Mailing Address - Street 1:1975 N JASMINE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-2801
Mailing Address - Country:US
Mailing Address - Phone:559-696-8046
Mailing Address - Fax:
Practice Address - Street 1:7370 N PALM AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5782
Practice Address - Country:US
Practice Address - Phone:559-696-8046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA615370207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A615370Medicaid
CAG82270Medicare UPIN
CA00A615370Medicaid