Healthcare Provider Details

I. General information

NPI: 1144271925
Provider Name (Legal Business Name): AMANDEEP S GILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/24/2021
Certification Date: 07/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W129N7055 NORTHFIELD DR
MENOMONEE FALLS WI
53051-0538
US

IV. Provider business mailing address

N54W16830 AUTUMN VIEW LN
MENOMONEE FALLS WI
53051-0654
US

V. Phone/Fax

Practice location:
  • Phone: 262-227-0091
  • Fax:
Mailing address:
  • Phone: 262-227-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number45949
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number45949
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: