MEDICARE: SHIVRAJPAL GREWAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	13202	OK

General Provider Information

NPI Number	:	1396713483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIVRAJPAL GREWAL M.D.

Provider Business Mailing Address
First Line	:	402 W MORROW RD
Second Line	:	100
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-6549
Country	:	US
Telephone Number	:	918-245-2309
Fax Number	:	918-293-3181

Provider Business Practice Location Address
First Line	:	402 W MORROW RD
Second Line	:	100
City	:	SAND SPRINGS
State	:	OK
Zip	:	74063-6549
Country	:	US
Telephone Number	:	918-245-2309
Fax Number	:	918-293-3181

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	10/29/2007

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