Provider Demographics
NPI:1518943778
Name:DHALIWAL, HARDEEP S (MD)
Entity Type:Individual
Prefix:
First Name:HARDEEP
Middle Name:S
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3871 LONG PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1569
Mailing Address - Country:US
Mailing Address - Phone:972-691-4444
Mailing Address - Fax:972-691-4440
Practice Address - Street 1:3871 LONG PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1569
Practice Address - Country:US
Practice Address - Phone:972-691-4444
Practice Address - Fax:972-691-4440
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122444604Medicaid
TX89Z330OtherBCBS OF TX
TX89Z330Medicare PIN
TX89Z330OtherBCBS OF TX