Healthcare Provider Details

I. General information

NPI: 1497491955
Provider Name (Legal Business Name): SONIA RANDHAWA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date: 12/19/2022
Reactivation Date: 07/10/2024

III. Provider practice location address

3175 W PROFESSIONAL DRIVE
BAY CITY MI
48706
US

IV. Provider business mailing address

82-68 164TH ST QUEENS HOSPITAL CENTER ROOM 28-21
JAMAICA, QUEENS NY
11432
US

V. Phone/Fax

Practice location:
  • Phone: 989-667-3377
  • Fax:
Mailing address:
  • Phone: 708-733-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301515438
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: