Healthcare Provider Details

I. General information

NPI: 1467496034
Provider Name (Legal Business Name): KAMALJIT SANDHU SINGH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S PAULINA ST SUITE 143
CHICAGO IL
60612-3806
US

IV. Provider business mailing address

PO BOX 239D
PARK RIDGE IL
60068-8018
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-2061
  • Fax: 312-942-2184
Mailing address:
  • Phone: 847-759-1560
  • Fax: 847-803-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036100785
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number036100785
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: