Basic Information
Provider Information
NPI: 1073882395
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHERGILL
FirstName: SUKHJIT
MiddleName: SINGH
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1115 SE 164TH AVE
Address2: SUITE 364
City: VANCOUVER
State: WA
PostalCode: 986839324
CountryCode: US
TelephoneNumber: 8772023597
FaxNumber:  
Practice Location
Address1: 4545 CORDATA PKWY
Address2: SUITE 2B
City: BELLINGHAM
State: WA
PostalCode: 982267263
CountryCode: US
TelephoneNumber: 3607382200
FaxNumber: 3607525683
Other Information
ProviderEnumerationDate: 12/15/2011
LastUpdateDate: 02/25/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD60408931WAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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