Provider Demographics
NPI:1790913812
Name:DHALIWAL, MIKE SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKE
Middle Name:SINGH
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11216 WOODMAR LN NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-6509
Mailing Address - Country:US
Mailing Address - Phone:714-651-8800
Mailing Address - Fax:
Practice Address - Street 1:1600 W AVENUE J
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2814
Practice Address - Country:US
Practice Address - Phone:661-949-5000
Practice Address - Fax:661-949-5971
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA108561207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACG401ZMedicare PIN