Healthcare Provider Details

I. General information

NPI: 1407032816
Provider Name (Legal Business Name): CARMICHAEL PEDIATRIC MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 JAMESON CT #1
CARMICHAEL CA
95608-0895
US

IV. Provider business mailing address

5841 JAMESON CT #1
CARMICHAEL CA
95608-0895
US

V. Phone/Fax

Practice location:
  • Phone: 916-485-9800
  • Fax: 916-485-9810
Mailing address:
  • Phone: 916-485-9800
  • Fax: 916-485-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA56390
License Number StateCA

VIII. Authorized Official

Name: DR. RAVINDER S KHAIRA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 916-485-9800