Provider Demographics
NPI:1740543180
Name:GILL, SUNDEEV SINGH (DO)
Entity type:Individual
Prefix:MR
First Name:SUNDEEV
Middle Name:SINGH
Last Name:GILL
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 1:3955 PATIENT CARE DR
Mailing Address - Street 2:STE A
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4299
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:517-374-9042
Practice Address - Street 1:3955 PATIENT CARE DR STE B
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4271
Practice Address - Country:US
Practice Address - Phone:517-882-6643
Practice Address - Fax:517-882-1949
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021450207R00000X
NVSL0899207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP01711195OtherMEDICARE RR
MI1740543180Medicaid
MI5330761OtherBCBS PIN
MI200000054869OtherPHP
MIC36084074Medicare PIN