Provider Demographics
NPI:1063645281
Name:HARPRIT K. BAJWA, D.P.M., INC
Entity Type:Organization
Organization Name:HARPRIT K. BAJWA, D.P.M., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SECRETARY/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARPRIT
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:530-676-3668
Mailing Address - Street 1:3106 PONTE MORINO DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8281
Mailing Address - Country:US
Mailing Address - Phone:530-676-3668
Mailing Address - Fax:530-676-3666
Practice Address - Street 1:3106 PONTE MORINO DR
Practice Address - Street 2:SUITE B
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8281
Practice Address - Country:US
Practice Address - Phone:530-676-3668
Practice Address - Fax:530-676-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4574213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E45740Medicare PIN
CA6314970001Medicare NSC
CAU85193Medicare UPIN