Healthcare Provider Details

I. General information

NPI: 1801566369
Provider Name (Legal Business Name): GAGANJOT SINGH KHURANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14125 W LISBON RD
BROOKFIELD WI
53005-1634
US

IV. Provider business mailing address

14125 W LISBON RD
BROOKFIELD WI
53005-1634
US

V. Phone/Fax

Practice location:
  • Phone: 262-364-7175
  • Fax: 262-806-4244
Mailing address:
  • Phone: 262-364-7175
  • Fax: 262-806-4244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: