MEDICARE: MANJIT 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	207RN0300X	Nephrology Physician	4301063741	MI
2	174400000X	Specialist	4301063741	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982694519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MANJIT GREWAL M.D.

Provider Business Mailing Address
First Line	:	3733 HERON RIDGE DR
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48309-4522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	G1071 N BALLENGER HWY
Second Line	:	SUITE 310
City	:	FLINT
State	:	MI
Zip	:	48504-4453
Country	:	US
Telephone Number	:	810-238-4172
Fax Number	:	810-238-4153

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	08/14/2018

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Directions to “ MANJIT GREWAL M.D.” Practice Location

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