Provider Demographics
NPI:1306160247
Name:SANDHU, HARJYOT (MD)
Entity type:Individual
Prefix:
First Name:HARJYOT
Middle Name:
Last Name:SANDHU
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 1:870 N MILWAUKEE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1521
Mailing Address - Country:US
Mailing Address - Phone:847-535-7647
Mailing Address - Fax:847-535-8109
Practice Address - Street 1:870 N MILWAUKEE AVE FL 2
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1521
Practice Address - Country:US
Practice Address - Phone:847-535-7647
Practice Address - Fax:847-535-8109
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124980207R00000X, 207RE0101X
IL036.124980208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036124980OtherILLINOIS PERMANENT PHYSICIAN LICENSE