Provider Demographics
NPI:1679675888
Name:GILL, AMARDEEP KAUR (MD)
Entity Type:Individual
Prefix:
First Name:AMARDEEP
Middle Name:KAUR
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 S J ST
Mailing Address - Street 2:FLOOR 3
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7503
Mailing Address - Fax:
Practice Address - Street 1:1608 S J ST
Practice Address - Street 2:FLOOR 3
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009017491207R00000X
MOT2006017134207R00000X
WAMD60233152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0301148OtherSTATE L&I
MO152360134Medicare PIN
WAG8906195Medicare PIN
WA0301148OtherSTATE L&I