Healthcare Provider Details

I. General information

NPI: 1285897132
Provider Name (Legal Business Name): CHIRANJIV SINGH VIRK M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 KINGS HWY
SHREVEPORT LA
71103-4228
US

IV. Provider business mailing address

8455 FERN AVE APT 1709
SHREVEPORT LA
71105-5771
US

V. Phone/Fax

Practice location:
  • Phone: 318-675-5000
  • Fax:
Mailing address:
  • Phone: 917-862-5505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD.204830
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: