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NPI Code Detail

MEDICARE: DR. DIVYAJOT SINGH SANDHU M.D.

MEDICARE: DR. DIVYAJOT SINGH SANDHU M.D.
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
12084V0102XVascular Neurology Physician10053SD
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1790915973
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIVYAJOT SINGH SANDHU M.D.
Provider Business Mailing Address
First Line : 3801 COOPER DR E
Second Line : APT 112
City : COLUMBIA
State : MO
Zip : 65201-7105
Country : US
Telephone Number : 317-640-4674
Fax Number :
Provider Business Practice Location Address
First Line : 1210 W 18TH ST STE 100
Second Line :
City : SIOUX FALLS
State : SD
Zip : 57104-4650
Country : US
Telephone Number : 605-312-8500
Fax Number : 605-312-8501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2009
Last Update Date : 07/21/2022

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