Provider Demographics
NPI:1851778203
Name:SANGHA, BIPPANJYOT SINGH (MD)
Entity type:Individual
Prefix:DR
First Name:BIPPANJYOT
Middle Name:SINGH
Last Name:SANGHA
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 1:251 E. HURON
Mailing Address - Street 2:RM 4-710X
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-622-2076
Mailing Address - Fax:
Practice Address - Street 1:251 EAST HURON
Practice Address - Street 2:RM. 4-710X
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-926-5113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2016-01-26
Deactivation Date:2015-12-10
Deactivation Code:
Reactivation Date:2016-01-26
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL125066190390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program