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General NPI Number Information
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NPI Number | 1912172149
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Entity Type | Individual
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Provider Name | PUSHPJEET SINGH KANWAR M.D
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Gender | Male
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Dates
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Enumeration Date | 04/29/2008
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 159 N 3RD ST
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City | MACCLENNY
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State | FL
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Zip | 32063-2103
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Country | US
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Telephone | 904-259-3151
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Fax |
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Provider Business Mailing Address
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Address Line | 159 N 3RD ST
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City | MACCLENNY
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State | FL
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Zip | 32063-2103
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Country | US
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Telephone | 904-259-3151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | D0083533
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME149153
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License Number State | FL
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