Provider Demographics
NPI:1932397601
Name:KULDIP GILL M D P C
Entity Type:Organization
Organization Name:KULDIP GILL M D P C
Other - Org Name:KULDIP GILL MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-273-8452
Mailing Address - Street 1:280 SIERRA COLLEGE DR.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-274-8452
Mailing Address - Fax:530-477-5182
Practice Address - Street 1:280 SIERRA COLLEGE DR.
Practice Address - Street 2:SUITE 205
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-274-8452
Practice Address - Fax:530-477-5182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28175ZMedicare PIN
CAG12425Medicare UPIN