Healthcare Provider Details

I. General information

NPI: 1225330285
Provider Name (Legal Business Name): SANTOSH SINGH MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 W KEM RD
MARION IN
46952-1735
US

IV. Provider business mailing address

1605 W KEM RD
MARION IN
46952-1735
US

V. Phone/Fax

Practice location:
  • Phone: 765-668-8071
  • Fax:
Mailing address:
  • Phone: 765-668-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number01035011A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number01035011A
License Number StateIN

VIII. Authorized Official

Name: SANTOSH K SINGH
Title or Position: OWNER
Credential: MD
Phone: 765-668-8071