Provider Demographics
NPI:1669497137
Name:SANDHU, SURINDER S (MD)
Entity Type:Individual
Prefix:
First Name:SURINDER
Middle Name:S
Last Name:SANDHU
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 1:7035 N MAPLE AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8007
Mailing Address - Country:US
Mailing Address - Phone:559-324-0111
Mailing Address - Fax:559-324-1414
Practice Address - Street 1:7035 N MAPLE AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8007
Practice Address - Country:US
Practice Address - Phone:559-324-0111
Practice Address - Fax:559-324-1414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA72592207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H29619Medicare UPIN