Healthcare Provider Details

I. General information

NPI: 1770229254
Provider Name (Legal Business Name): MALVINDERJIT SINGH MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/09/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2635
US

IV. Provider business mailing address

23821 N 64TH AVE
GLENDALE AZ
85310-3412
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-1505
  • Fax:
Mailing address:
  • Phone: 480-213-0232
  • Fax: 623-440-7820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANNA QUINONES
Title or Position: BILLING MANAGER
Credential:
Phone: 480-213-0232