Healthcare Provider Details

I. General information

NPI: 1487216602
Provider Name (Legal Business Name): ATWAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N FLAGLER DR STE 350
WEST PALM BEACH FL
33401-4349
US

IV. Provider business mailing address

515 N FLAGLER DR STE 350
WEST PALM BEACH FL
33401-4349
US

V. Phone/Fax

Practice location:
  • Phone: 904-364-9985
  • Fax: 650-897-5097
Mailing address:
  • Phone: 904-364-9985
  • Fax: 650-897-5097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PALDEEP SINGH ATWAL
Title or Position: DIRECTOR
Credential: MD
Phone: 904-364-9985