Provider Demographics
NPI:1548200728
Name:SANDHU, JAGVEER S (MD)
Entity Type:Individual
Prefix:
First Name:JAGVEER
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 1:13640 N PLAZA DEL RIO BLVD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4846
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-977-4223
Practice Address - Street 1:13760 N 93RD AVE
Practice Address - Street 2:STE 101
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4201
Practice Address - Country:US
Practice Address - Phone:623-876-3940
Practice Address - Fax:623-977-4223
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ190192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ293291Medicaid
AZ130013133Medicare PIN
AZE07642Medicare UPIN
AZ293291Medicaid
AZZWCKJD60Medicare PIN