MEDICARE: HARMANDEEP K. GILL MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1083896849
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARMANDEEP K. GILL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1770 IOWA AVE
Second Line	:	SUITE 280
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2430
Country	:	US
Telephone Number	:	951-786-0801
Fax Number	:	951-786-0460

Provider Business Practice Location Address
First Line	:	1770 IOWA AVE
Second Line	:	SUITE 280
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2430
Country	:	US
Telephone Number	:	951-786-0801
Fax Number	:	951-786-0460

Authorized Official
Title or Position	:	OWNER
Name	:	HARMANDEEP K. GILL
Credential	:	MD
Telephone Number	:	661-948-4781

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	07/10/2008

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