Provider Demographics
NPI:1699778134
Name:KHALSA, SANTSINGH (MD)
Entity type:Individual
Prefix:MR
First Name:SANTSINGH
Middle Name:
Last Name:KHALSA
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 1:899 N WILMOT RD
Mailing Address - Street 2:STE C2
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1712
Mailing Address - Country:US
Mailing Address - Phone:520-745-6946
Mailing Address - Fax:520-747-2454
Practice Address - Street 1:899 N WILMOT RD
Practice Address - Street 2:STE C2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1712
Practice Address - Country:US
Practice Address - Phone:520-745-6946
Practice Address - Fax:520-747-2454
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ13205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ209579Medicaid