Healthcare Provider Details

I. General information

NPI: 1164003232
Provider Name (Legal Business Name): GAGAN GREWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 NAIL AVENUE, SUITE 200
OVERLAND PARK KS
66211
US

IV. Provider business mailing address

10730 NAIL AVENUE SUITE 200
OVERLAND PARK KS
66211
US

V. Phone/Fax

Practice location:
  • Phone: 913-945-9892
  • Fax:
Mailing address:
  • Phone: 913-945-9892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number04-53434
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: