Healthcare Provider Details

I. General information

NPI: 1346348919
Provider Name (Legal Business Name): BAL KRISHNA KHANDELWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRIMARY CARE CLINIC OF NORTH TEXAS (CHARITY CLINIC) 3900 AMERICAN DRIVE, #201
PLANO TX
75075
US

IV. Provider business mailing address

6113 MARTINOVE STREET
PLANO TX
75024
US

V. Phone/Fax

Practice location:
  • Phone: 972-596-6005
  • Fax: 972-596-6004
Mailing address:
  • Phone: 432-352-0334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberE9266
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: