Provider Demographics
NPI:1013966621
Name:BAINS, JAGDEEP K (MD)
Entity Type:Individual
Prefix:MRS
First Name:JAGDEEP
Middle Name:K
Last Name:BAINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13927 W GRAND AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-2438
Mailing Address - Country:US
Mailing Address - Phone:623-544-6963
Mailing Address - Fax:623-975-5486
Practice Address - Street 1:13927 W GRAND AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-2438
Practice Address - Country:US
Practice Address - Phone:623-544-6963
Practice Address - Fax:623-975-5486
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29311207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG74345Medicare UPIN