MEDICARE: MR. SANDEEP K. ATWAL APN

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	363LF0000X	Family Nurse Practitioner	277.003009	IL

General Provider Information

NPI Number	:	1245801059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SANDEEP K. ATWAL APN

Provider Business Mailing Address
First Line	:	10714 S ROBERTS RD
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-2314
Country	:	US
Telephone Number	:	708-631-1326
Fax Number	:

Provider Business Practice Location Address
First Line	:	10714 S ROBERTS RD
Second Line	:
City	:	PALOS HILLS
State	:	IL
Zip	:	60465-2314
Country	:	US
Telephone Number	:	708-631-1326
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2021
Last Update Date	:	05/19/2025

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