Healthcare Provider Details

I. General information

NPI: 1447934013
Provider Name (Legal Business Name): GAVIN RANDHAWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S SANTA FE AVE STE 100
SALINA KS
67401-4189
US

IV. Provider business mailing address

501 S SANTA FE AVE STE 100
SALINA KS
67401-4189
US

V. Phone/Fax

Practice location:
  • Phone: 785-825-2273
  • Fax: 785-825-2275
Mailing address:
  • Phone: 785-825-2273
  • Fax: 785-825-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04-53646
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: