| |
13927 W Grand Ave Suite 401 Surprise AZ 85374-2438 | |
(623) 544-6963 | |
(623) 975-5486 |
Full Name | |
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Speciality | Internal Medicine |
Location | 13927 W Grand Ave, Surprise, Arizona |
Authorized Official Name and Position | Jagdeep Bains (SECRETARY) |
Authorized Official Contact | 6235446963 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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13927 W Grand Ave Suite 401 Surprise AZ 85374-2438 Ph: (623) 544-6963 | 13927 W Grand Ave Suite 401 Surprise AZ 85374-2438 Ph: (623) 544-6963 |
NPI Number | 1730138413 |
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Provider Enumeration Date | 05/09/2006 |
Last Update Date | 07/21/2022 |
Medicare PECOS PAC ID | 0648262915 |
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Medicare Enrollment ID | O20040330001022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730138413 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | 29311 (Arizona) | Primary |
Provider Name | Jagdeep K Bains |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1013966621 PECOS PAC ID: 2961494240 Enrollment ID: I20110121000955 |
Provider Name | Navjot K Rakkar |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1598714263 PECOS PAC ID: 4789676065 Enrollment ID: I20110126000164 |
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