Provider Demographics
NPI:1871508556
Name:KHALSA, DHARAMPAL (DO)
Entity Type:Individual
Prefix:
First Name:DHARAMPAL
Middle Name:
Last Name:KHALSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 S SAINT FRANCIS DR STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4098
Mailing Address - Country:US
Mailing Address - Phone:505-946-7610
Mailing Address - Fax:505-303-3001
Practice Address - Street 1:1482 S SAINT FRANCIS DR STE C
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4098
Practice Address - Country:US
Practice Address - Phone:505-946-7951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1961-16204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0000000Medicaid