MEDICARE: NAVJOT BAJWA MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	K5790	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881913028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAVJOT BAJWA MD PA

Provider Business Mailing Address
First Line	:	11751 ALTA VISTA RD
Second Line	:	SUITE 103
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6407
Country	:	US
Telephone Number	:	817-623-2012
Fax Number	:	817-623-2009

Provider Business Practice Location Address
First Line	:	11751 ALTA VISTA RD
Second Line	:	SUITE 103
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6407
Country	:	US
Telephone Number	:	817-623-2012
Fax Number	:	817-623-2009

Authorized Official
Title or Position	:	PROVIDER
Name	:	NAVJOT BAJWA
Credential	:	M.D.
Telephone Number	:	817-623-2012

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	09/04/2014

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