Provider Demographics
NPI:1396628210
Name:JOHAL, AMANOOR SINGH
Entity type:Individual
Prefix:
First Name:AMANOOR
Middle Name:SINGH
Last Name:JOHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E PINE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-4831
Mailing Address - Country:US
Mailing Address - Phone:732-397-0827
Mailing Address - Fax:
Practice Address - Street 1:715 CLINIC DR
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47907-2122
Practice Address - Country:US
Practice Address - Phone:317-274-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program