Provider Demographics
NPI:1700842697
Name:GREWAL, HARPREET SINGH (MD)
Entity Type:Individual
Prefix:
First Name:HARPREET
Middle Name:SINGH
Last Name:GREWAL
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 1:530 W EATON AVE STE K
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376
Mailing Address - Country:US
Mailing Address - Phone:209-835-4232
Mailing Address - Fax:209-835-3246
Practice Address - Street 1:530 W EATON AVE STE K
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376
Practice Address - Country:US
Practice Address - Phone:209-835-4232
Practice Address - Fax:209-835-3246
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40558207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A405580Medicaid
CAA29147Medicare UPIN
CA00A405580Medicaid