Provider Demographics
NPI:1477650513
Name:B.K. KHANDELWAL M.D ASSOCIATES
Entity Type:Organization
Organization Name:B.K. KHANDELWAL M.D ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHANDELWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:432-684-0941
Mailing Address - Street 1:2301 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-5829
Mailing Address - Country:US
Mailing Address - Phone:432-684-0941
Mailing Address - Fax:432-570-5600
Practice Address - Street 1:2301 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-5829
Practice Address - Country:US
Practice Address - Phone:432-684-0941
Practice Address - Fax:432-570-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9266207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085583501Medicaid
TXB23925Medicare UPIN
TX00U20QMedicare ID - Type Unspecified