Healthcare Provider Details

I. General information

NPI: 1194411421
Provider Name (Legal Business Name): SUNPREET SINGH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 E DUPONT RD
FORT WAYNE IN
46825-1675
US

IV. Provider business mailing address

11885 E 12 MILE RD STE 300A
WARREN MI
48093-3467
US

V. Phone/Fax

Practice location:
  • Phone: 260-416-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02009029A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: