Healthcare Provider Details

I. General information

NPI: 1225262264
Provider Name (Legal Business Name): SIMRAN SEKHON M.B.B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SIMRAN SANDHU M.D.

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9143 CEDAR RIDGE DR
GRANITE BAY CA
95746-7234
US

IV. Provider business mailing address

140 HEMSTEAD ST
LAKE BLUFF IL
60044-1155
US

V. Phone/Fax

Practice location:
  • Phone: 352-870-8135
  • Fax:
Mailing address:
  • Phone: 847-735-1524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA106324
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: