Provider Demographics
NPI:1467798843
Name:AJANAMJOT K GREWAL MD INC
Entity Type:Organization
Organization Name:AJANAMJOT K GREWAL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJANAMJOT
Authorized Official - Middle Name:K
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-790-0005
Mailing Address - Street 1:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:4231 US HIGHWAY 86
Practice Address - Street 2:SUITE 6
Practice Address - City:BRAWLEY
Practice Address - State:CA
Practice Address - Zip Code:92227-9648
Practice Address - Country:US
Practice Address - Phone:760-790-0005
Practice Address - Fax:760-344-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGX430XMedicare PIN