Provider Demographics
NPI:1790700458
Name:GILL, HARMANDEEP K (MD)
Entity Type:Individual
Prefix:
First Name:HARMANDEEP
Middle Name:K
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:PO BOX 26750
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6750
Mailing Address - Country:US
Mailing Address - Phone:661-948-4781
Mailing Address - Fax:
Practice Address - Street 1:43830 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4826
Practice Address - Country:US
Practice Address - Phone:661-948-4781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA514522085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A514520Medicaid
CA00A514520Medicaid
G54178Medicare UPIN
CA00A514520Medicare PIN
CAP00059962Medicare PIN