Healthcare Provider Details

I. General information

NPI: 1740592815
Provider Name (Legal Business Name): SAMINDER SINGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 N US HIGHWAY 1 STE 100
PORT ST JOHN FL
32927-5034
US

IV. Provider business mailing address

5961 N LINCOLN AVE STE 102
CHICAGO IL
60659-3758
US

V. Phone/Fax

Practice location:
  • Phone: 321-637-1595
  • Fax: 321-637-1596
Mailing address:
  • Phone: 312-702-3923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036135921
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME126037
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301096708
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01072965A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: