Provider Demographics
NPI:1578592754
Name:CHARANJIT DHILLON, MD, PC
Entity Type:Organization
Organization Name:CHARANJIT DHILLON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARANJIT
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-395-0718
Mailing Address - Street 1:6707 N 19TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-1104
Mailing Address - Country:US
Mailing Address - Phone:602-395-0718
Mailing Address - Fax:602-277-8146
Practice Address - Street 1:6707 N 19TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-1104
Practice Address - Country:US
Practice Address - Phone:602-395-0718
Practice Address - Fax:602-277-8146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11273207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ210964Medicaid
AZZMD11273Medicare PIN
AZ210964Medicaid