Healthcare Provider Details

I. General information

NPI: 1174360606
Provider Name (Legal Business Name): MD PARTNERS IPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 07/11/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 SIERRA COLLEGE DR STE #205
GRASS VALLEY CA
95945-5726
US

IV. Provider business mailing address

280 SIERRA COLLEGE DR STE #205
GRASS VALLEY CA
95945-5726
US

V. Phone/Fax

Practice location:
  • Phone: 657-217-4500
  • Fax: 657-206-3375
Mailing address:
  • Phone: 657-217-4500
  • Fax: 657-206-3375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. KULDIP S GILL
Title or Position: PRESIDENTCEO
Credential: M.D.
Phone: 530-263-5349