Provider Demographics
NPI:1215135462
Name:SANDHU, HARPREET KAUR (MD)
Entity type:Individual
Prefix:
First Name:HARPREET
Middle Name:KAUR
Last Name:SANDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HARPREET
Other - Middle Name:KAUR
Other - Last Name:JOHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2940 N LITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7830
Mailing Address - Country:US
Mailing Address - Phone:623-535-0050
Mailing Address - Fax:
Practice Address - Street 1:2940 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7830
Practice Address - Country:US
Practice Address - Phone:623-535-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL1754390200000X
AZ470792084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL1754OtherNV MEDICAL LIC
AZ791429Medicaid
AZZ158455Medicare PIN