Provider Demographics
NPI:1568740033
Name:RANDHAWA, AMANDEEP SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDEEP
Middle Name:SINGH
Last Name:RANDHAWA
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 1:4801 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-2609
Mailing Address - Country:US
Mailing Address - Phone:773-378-8100
Mailing Address - Fax:773-378-8100
Practice Address - Street 1:4801 W LAKE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-2609
Practice Address - Country:US
Practice Address - Phone:773-378-8100
Practice Address - Fax:773-378-8100
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036137608207P00000X, 207QG0300X
MI4301099622207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine