Healthcare Provider Details

I. General information

NPI: 1538689989
Provider Name (Legal Business Name): GAURAVPAL SINGH GILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 06/24/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CHARLES DIMMOCK PARKWAY SUITE 100
COLONIAL HEIGHTS VA
23834
US

IV. Provider business mailing address

MAIL ROUTE: 33300 920 EAST 28TH STREET
MINNEAPOLIS MN
55407
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-1764
  • Fax:
Mailing address:
  • Phone: 612-863-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101279772
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: