Provider Demographics
NPI:1548397995
Name:SANDHU, PRITPAL (MD)
Entity Type:Individual
Prefix:
First Name:PRITPAL
Middle Name:
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 1:14674 W MOUNTAIN VIEW BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2708
Mailing Address - Country:US
Mailing Address - Phone:623-876-3800
Mailing Address - Fax:623-876-6965
Practice Address - Street 1:14416 W MEEKER BLVD
Practice Address - Street 2:STE 300
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-5284
Practice Address - Country:US
Practice Address - Phone:623-583-5271
Practice Address - Fax:623-583-6535
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ357232Medicaid
AZP00654783OtherMEDICARE RAILROAD#
AZP00654783OtherMEDICARE RAILROAD#