Provider Demographics
NPI:1689961351
Name:GREWAL, PREETKANWAL K (MD)
Entity Type:Individual
Prefix:
First Name:PREETKANWAL
Middle Name:K
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PREETKANWAL
Other - Middle Name:
Other - Last Name:BRAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:202-272-5116
Practice Address - Street 1:1930 BISHOP LN STE 1600
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-272-5044
Practice Address - Fax:502-272-5121
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099335207Q00000X
KY47085207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301099335OtherST LICENSE