Healthcare Provider Details

I. General information

NPI: 1932180031
Provider Name (Legal Business Name): MANJIT LAL SANDHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N SHERIDAN RD SUITE 502
CHICAGO IL
60657-6156
US

IV. Provider business mailing address

PO BOX 3603
OAK BROOK IL
60522-3603
US

V. Phone/Fax

Practice location:
  • Phone: 773-472-1483
  • Fax: 773-472-1489
Mailing address:
  • Phone: 312-471-5550
  • Fax: 312-471-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036089775
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: