Provider Demographics
NPI:1164834255
Name:GOLWALA, AMOL
Entity Type:Individual
Prefix:
First Name:AMOL
Middle Name:
Last Name:GOLWALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 S WATERFORD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-2975
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 CLARA BARTON BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-5738
Practice Address - Country:US
Practice Address - Phone:469-800-2279
Practice Address - Fax:469-800-2280
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050930207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine