Provider Demographics
NPI:1932180031
Name:SANDHU, MANJIT LAL (MD)
Entity Type:Individual
Prefix:DR
First Name:MANJIT
Middle Name:LAL
Last Name:SANDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3603
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60522-3603
Mailing Address - Country:US
Mailing Address - Phone:312-471-5550
Mailing Address - Fax:312-471-5551
Practice Address - Street 1:2800 N SHERIDAN RD
Practice Address - Street 2:SUITE 502
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6156
Practice Address - Country:US
Practice Address - Phone:773-472-1483
Practice Address - Fax:773-472-1489
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360897752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089775Medicaid
IL10760334OtherCAQH
IL10760334OtherCAQH
ILBS2923680OtherDEA
IL036089775Medicaid