Provider Demographics
NPI:1083735765
Name:GREWAL, JASVEER (MD)
Entity Type:Individual
Prefix:DR
First Name:JASVEER
Middle Name:
Last Name:GREWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:GREWAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:700 E BEARDSLEY AVE STE 4B
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3366
Mailing Address - Country:US
Mailing Address - Phone:574-304-1519
Mailing Address - Fax:574-350-2441
Practice Address - Street 1:700 E BEARDSLEY AVE STE 4B
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3366
Practice Address - Country:US
Practice Address - Phone:574-304-1519
Practice Address - Fax:574-350-2441
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063994A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine