Provider Demographics
NPI:1457389447
Name:DHALLA, MANDEEP SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANDEEP
Middle Name:SINGH
Last Name:DHALLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6333 N FEDERAL HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1907
Mailing Address - Country:US
Mailing Address - Phone:954-776-6880
Mailing Address - Fax:954-229-3100
Practice Address - Street 1:6333 N FEDERAL HWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-776-6880
Practice Address - Fax:954-776-6895
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98620207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28072OtherBCBSFL
198538OtherMO-BLUE SHIELD
134472Medicare UPIN