Provider Demographics
NPI:1912168931
Name:DHALIWAL, SUPREET KAUR
Entity Type:Individual
Prefix:MRS
First Name:SUPREET
Middle Name:KAUR
Last Name:DHALIWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SUPREET
Other - Middle Name:KAUR
Other - Last Name:GHUMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2371 BOWES RD
Mailing Address - Street 2:STE 400
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:224-227-6973
Mailing Address - Fax:
Practice Address - Street 1:2371 BOWES RD
Practice Address - Street 2:STE 400
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:224-227-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005367213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery