Provider Demographics
NPI:1316233265
Name:SANDHU, MANPREET KAUR (MD)
Entity type:Individual
Prefix:
First Name:MANPREET
Middle Name:KAUR
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 1:815 E 5TH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6471
Mailing Address - Country:US
Mailing Address - Phone:618-474-4855
Mailing Address - Fax:618-474-6468
Practice Address - Street 1:815 E 5TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-6471
Practice Address - Country:US
Practice Address - Phone:618-474-4855
Practice Address - Fax:618-474-6468
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08862100207R00000X
IL036132385207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL384230037Medicare UPIN