Healthcare Provider Details

I. General information

NPI: 1881335602
Provider Name (Legal Business Name): INDERSUKHPREET RANDHAWA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N LA CHOLLA BLVD
TUCSON AZ
85741-3529
US

IV. Provider business mailing address

13128 WALNUT LAKE RD
HOUSTON TX
77065-3223
US

V. Phone/Fax

Practice location:
  • Phone: 520-742-9000
  • Fax:
Mailing address:
  • Phone: 832-312-3729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number76986
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: