Provider Demographics
NPI:1699706341
Name:BHAMRAH, MANJIT (MD)
Entity type:Individual
Prefix:
First Name:MANJIT
Middle Name:
Last Name:BHAMRAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13606 N 59TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-1270
Mailing Address - Country:US
Mailing Address - Phone:602-978-6100
Mailing Address - Fax:
Practice Address - Street 1:13606 N 59TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-1270
Practice Address - Country:US
Practice Address - Phone:602-978-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21668207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21668OtherAZ LICENSE
AZ154948Medicaid
AZF62473Medicare UPIN
AZ60526Medicare ID - Type Unspecified