Provider Demographics
NPI:1952337123
Name:RANDHAWA, SURINDER KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:SURINDER
Middle Name:KAUR
Last Name:RANDHAWA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-604-3170
Mailing Address - Fax:405-948-2745
Practice Address - Street 1:5100 N BROOKLINE AVE # 900
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3623
Practice Address - Country:US
Practice Address - Phone:405-604-3170
Practice Address - Fax:405-948-2745
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK188712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100035840AMedicaid
OKG04628Medicare UPIN
OK241419702Medicare ID - Type Unspecified