Healthcare Provider Details

I. General information

NPI: 1053671529
Provider Name (Legal Business Name): TARANDEEP SINGH GREWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5443 W MOLLY LN
PHOENIX AZ
85083-6376
US

IV. Provider business mailing address

5749 W PINNACLE HILL DR
GLENDALE AZ
85310-3632
US

V. Phone/Fax

Practice location:
  • Phone: 602-773-1120
  • Fax:
Mailing address:
  • Phone:
  • Fax: 480-478-6628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT201636
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50196
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50196
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: