Provider Demographics
NPI:1528034477
Name:SANDHU, JAGDEEP S (MD)
Entity Type:Individual
Prefix:
First Name:JAGDEEP
Middle Name:S
Last Name:SANDHU
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 1:519 E BLOOMINGDALE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8180
Mailing Address - Country:US
Mailing Address - Phone:813-655-4100
Mailing Address - Fax:813-655-1775
Practice Address - Street 1:519 E BLOOMINGDALE AVE
Practice Address - Street 2:A
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8105
Practice Address - Country:US
Practice Address - Phone:813-655-4100
Practice Address - Fax:813-655-1775
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL73640207R00000X
FLME73640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010063425OtherRAILROAD MEDICARE
FL42218OtherBCBS OF FL
FL010063425OtherRAILROAD MEDICARE
FL42218ZMedicare PIN
FL42218Medicare ID - Type Unspecified
FL42218YMedicare PIN