Provider Demographics
NPI:1861486607
Name:SINGH, GURDEV (MD)
Entity type:Individual
Prefix:DR
First Name:GURDEV
Middle Name:
Last Name:SINGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18301 N 79TH AVE STE G190
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6093
Mailing Address - Country:US
Mailing Address - Phone:602-932-8597
Mailing Address - Fax:
Practice Address - Street 1:18301 N 79TH AVE STE G190
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6093
Practice Address - Country:US
Practice Address - Phone:602-932-8597
Practice Address - Fax:602-848-4696
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-08
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34031207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ938152Medicaid
AZZ103589Medicare ID - Type Unspecified
AZ116124Medicare PIN
AZ938152Medicaid