Provider Demographics
NPI:1417130337
Name:DEEPAK SARWAL, MD, LLC
Entity Type:Organization
Organization Name:DEEPAK SARWAL, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-291-0839
Mailing Address - Street 1:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:BELLBROOK
Mailing Address - State:OH
Mailing Address - Zip Code:45305-0186
Mailing Address - Country:US
Mailing Address - Phone:937-291-0839
Mailing Address - Fax:937-291-0854
Practice Address - Street 1:5563 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2225
Practice Address - Country:US
Practice Address - Phone:937-291-0839
Practice Address - Fax:937-291-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077166207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2141079Medicaid
OH2937022 GROUPMedicaid
OH9351051Medicare PIN
OH2937022 GROUPMedicaid