Provider Demographics
NPI:1558447250
Name:DEOL, SHIVINDER SINGH (MD)
Entity Type:Individual
Prefix:
First Name:SHIVINDER
Middle Name:SINGH
Last Name:DEOL
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 1:4000 STOCKDALE HWY
Mailing Address - Street 2:STE D
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309
Mailing Address - Country:US
Mailing Address - Phone:661-325-7452
Mailing Address - Fax:661-325-7456
Practice Address - Street 1:4000 STOCKDALE HWY
Practice Address - Street 2:STE D
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:661-325-7452
Practice Address - Fax:661-325-7456
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ72897ZMedicaid
00A377230Medicare ID - Type Unspecified
CAZZZ72897ZMedicaid