Healthcare Provider Details

I. General information

NPI: 1700842697
Provider Name (Legal Business Name): HARPREET SINGH GREWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 W EATON AVE STE K
TRACY CA
95376
US

IV. Provider business mailing address

530 W EATON AVE STE K
TRACY CA
95376
US

V. Phone/Fax

Practice location:
  • Phone: 209-835-4232
  • Fax: 209-835-3246
Mailing address:
  • Phone: 209-835-4232
  • Fax: 209-835-3246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA40558
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: