=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871866871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRIMARY CARE WALK IN CLINIC,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2012
-----------------------------------------------------
Last Update Date | 11/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6329 STATE ROAD 54
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-6037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-844-5555
-----------------------------------------------------
Fax | 727-844-5553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6329 STATE ROAD 54
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34653-6037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-844-5555
-----------------------------------------------------
Fax | 727-844-5553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | TEJINDER K DHALIWAL
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 727-844-5555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------