Provider Demographics
NPI:1336233204
Name:RANDHAWA, RAVINDER SINGH (DO)
Entity Type:Individual
Prefix:DR
First Name:RAVINDER
Middle Name:SINGH
Last Name:RANDHAWA
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 1:16244 MILITARY TRL
Mailing Address - Street 2:SUITE 710
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6534
Mailing Address - Country:US
Mailing Address - Phone:561-638-8505
Mailing Address - Fax:561-638-8504
Practice Address - Street 1:16244 MILITARY TRL
Practice Address - Street 2:SUITE 710
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6534
Practice Address - Country:US
Practice Address - Phone:561-638-8505
Practice Address - Fax:561-638-8504
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007402207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG63127Medicare UPIN
FL57534Medicare PIN