Healthcare Provider Details

I. General information

NPI: 1154492569
Provider Name (Legal Business Name): JAGROOP SINGH BASRAON D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 04/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-0001
US

IV. Provider business mailing address

1313 E HERNDON AVE SUITE 203
FRESNO CA
93720-3306
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-1530
  • Fax:
Mailing address:
  • Phone: 559-439-6808
  • Fax: 559-439-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number60038-21
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number10902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: