Healthcare Provider Details

I. General information

NPI: 1245328988
Provider Name (Legal Business Name): AMARDEEP SINGH AHLUWALIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 29TH ST STE 480
SACRAMENTO CA
95816
US

IV. Provider business mailing address

10470 OLD PLACERVILLE RD STE 100
SACRAMENTO CA
95827-2539
US

V. Phone/Fax

Practice location:
  • Phone: 916-887-0780
  • Fax: 916-887-0786
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-503-7199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA92906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: