Provider Demographics
NPI:1649209644
Name:KAHLON, GURJEET SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:GURJEET
Middle Name:SINGH
Last Name:KAHLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6611 CLYO RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-2786
Mailing Address - Country:US
Mailing Address - Phone:937-208-8282
Mailing Address - Fax:937-208-8276
Practice Address - Street 1:6611 CLYO RD
Practice Address - Street 2:SUITE E
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2786
Practice Address - Country:US
Practice Address - Phone:937-208-8282
Practice Address - Fax:937-208-8276
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35088496207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2706432Medicaid
OH9324321OtherVALLEY MEDICAL PRIMARY CARE GROUP MEDICARE NUMBER
1528127610OtherVALLEY MEDICAL PRIMARY CARE INC- NPI #
OHI65594Medicare UPIN
OH2706432Medicaid