Provider Demographics
NPI:1598750648
Name:DHALIWAL, GUNWANT S (MD)
Entity Type:Individual
Prefix:DR
First Name:GUNWANT
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 1:6329 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-6037
Mailing Address - Country:US
Mailing Address - Phone:727-844-5555
Mailing Address - Fax:727-844-5550
Practice Address - Street 1:6329 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-6037
Practice Address - Country:US
Practice Address - Phone:727-844-5555
Practice Address - Fax:727-844-5550
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110076211OtherRAILROAD MEDICARE WITH GRP# CH0801
FL102190OtherAVMED
FL23620OtherBCBS
FLF70027Medicare UPIN
FL23620ZMedicare PIN
FL23620ZMedicare PIN