Provider Demographics
NPI:1023000270
Name:GREWAL, RAMAN S (MD)
Entity Type:Individual
Prefix:
First Name:RAMAN
Middle Name:S
Last Name:GREWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W LAKE MEAD PKWY
Mailing Address - Street 2:B-18
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-7055
Mailing Address - Country:US
Mailing Address - Phone:702-564-4440
Mailing Address - Fax:702-558-1522
Practice Address - Street 1:129 W LAKE MEAD PKWY
Practice Address - Street 2:B-18
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7055
Practice Address - Country:US
Practice Address - Phone:702-564-4440
Practice Address - Fax:702-558-1522
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10879207L00000X
CAA77029207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1023000270Medicaid
NVDS415ZMedicare PIN