Healthcare Provider Details

I. General information

NPI: 1841234168
Provider Name (Legal Business Name): HARINDER SINGH GREWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 LORETTO RD STE 700
LEBANON KY
40033-1308
US

IV. Provider business mailing address

330 LORETTO RD STE 700
LEBANON KY
40033-1308
US

V. Phone/Fax

Practice location:
  • Phone: 270-692-6744
  • Fax: 270-692-6229
Mailing address:
  • Phone: 270-692-6744
  • Fax: 270-692-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35697
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: