Provider Demographics
NPI:1740592815
Name:SINGH, SAMINDER (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMINDER
Middle Name:
Last Name:SINGH
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 1:5961 N LINCOLN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3758
Mailing Address - Country:US
Mailing Address - Phone:312-702-3923
Mailing Address - Fax:
Practice Address - Street 1:7227 N US HIGHWAY 1 STE 100
Practice Address - Street 2:
Practice Address - City:PORT ST JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-5034
Practice Address - Country:US
Practice Address - Phone:321-637-1595
Practice Address - Fax:321-637-1596
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036135921207Q00000X
FLME126037207Q00000X
MI4301096708207Q00000X
IN01072965A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLLI684OtherMEDICARE