Provider Demographics
NPI:1124328273
Name:SHIVINDER S. DEOL M.D., INC.
Entity type:Organization
Organization Name:SHIVINDER S. DEOL M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-325-7452
Mailing Address - Street 1:4000 STOCKDALE HWY
Mailing Address - Street 2:STE D
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-2059
Mailing Address - Country:US
Mailing Address - Phone:661-325-7452
Mailing Address - Fax:661-325-7456
Practice Address - Street 1:4000 STOCKDALE HWY
Practice Address - Street 2:STE D
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-2059
Practice Address - Country:US
Practice Address - Phone:661-325-7452
Practice Address - Fax:661-325-7456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
080004729OtherPTAN
CA84411017Medicaid
0021377230Medicare NSC
080004729OtherPTAN
00A377230Medicare Oscar/Certification