Healthcare Provider Details

I. General information

NPI: 1770580888
Provider Name (Legal Business Name): SUKHWINDER S GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

IV. Provider business mailing address

7605 PEAR TREE LN
SYLVANIA OH
43560-4417
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-7701
  • Fax: 419-696-7866
Mailing address:
  • Phone: 419-696-7701
  • Fax: 419-696-7866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35067043-G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: