Provider Demographics
NPI:1760588966
Name:GURKIRPAL S SHERGILL MD PA
Entity Type:Organization
Organization Name:GURKIRPAL S SHERGILL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GURKIRPAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-293-3909
Mailing Address - Street 1:295 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844
Mailing Address - Country:US
Mailing Address - Phone:863-293-3909
Mailing Address - Fax:863-293-1909
Practice Address - Street 1:295 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844
Practice Address - Country:US
Practice Address - Phone:863-293-3909
Practice Address - Fax:863-293-1909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0077030173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9552Medicare ID - Type Unspecified