Healthcare Provider Details

I. General information

NPI: 1255513909
Provider Name (Legal Business Name): MANPREET SINGH GREWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N FEDERAL HWY STE 101
POMPANO BEACH FL
33062
US

IV. Provider business mailing address

4608 SWILCAN BRIDGE LN S
JACKSONVILLE FL
32224-5620
US

V. Phone/Fax

Practice location:
  • Phone: 954-807-9545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME96458
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME96458
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: