Provider Demographics
NPI:1053361238
Name:DHILLON, SARTAJ K (MD)
Entity type:Individual
Prefix:
First Name:SARTAJ
Middle Name:K
Last Name:DHILLON
Suffix:
Gender:F
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:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-0580
Mailing Address - Country:US
Mailing Address - Phone:559-386-4500
Mailing Address - Fax:559-282-5080
Practice Address - Street 1:229 W CHERRY AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257
Practice Address - Country:US
Practice Address - Phone:559-784-5717
Practice Address - Fax:559-784-2443
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34218-020207R00000X
CAA53571207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1053361238Medicaid
WI110199300Medicare PIN
WI1053361238Medicaid
WIDHILLSAROtherMERCYCARE
WI32092000Medicaid
WI110230121Medicare PIN
WI000454375Medicare PIN