Healthcare Provider Details

I. General information

NPI: 1548397995
Provider Name (Legal Business Name): PRITPAL SANDHU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14674 W MOUNTAIN VIEW BLVD STE 200
SURPRISE AZ
85374-2708
US

IV. Provider business mailing address

14674 W MOUNTAIN VIEW BLVD STE 200
SURPRISE AZ
85374-2708
US

V. Phone/Fax

Practice location:
  • Phone: 623-544-6860
  • Fax: 623-544-6861
Mailing address:
  • Phone: 623-876-3800
  • Fax: 623-876-6965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40128
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: