Provider Demographics
NPI:1871518282
Name:SABHARWAL, JAGDEEP (MD)
Entity type:Individual
Prefix:
First Name:JAGDEEP
Middle Name:
Last Name:SABHARWAL
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 1:4665 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-8158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1818 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3454
Practice Address - Country:US
Practice Address - Phone:920-731-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36096670207RC0000X, 207RI0011X, 207UN0901X, 2085B0100X, 2085R0204X, 2085U0001X
IN01073485A207RC0000X, 207RI0011X
IL036096670207RI0011X
WI62102-20207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096670Medicaid
IN201224120Medicaid
IN000000982629OtherANTHEM PROVIDER NUMBER
IL101 15504OtherB/C B/S OF ILLINOIS
IL036096670 1Medicaid
IL036096670 1Medicaid
GACB0709/060070356OtherRR MEDICARE GROUP ID#/PIN
IN201224120Medicaid
ILL94731Medicare PIN
IN000000982629OtherANTHEM PROVIDER NUMBER