Provider Demographics
NPI:1760428262
Name:AHLUWALIA, MICKY S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICKY
Middle Name:S
Last Name:AHLUWALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SWARANJIT
Other - Middle Name:M
Other - Last Name:AHLUWALIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2521 TIMBER COVE LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8832
Mailing Address - Country:US
Mailing Address - Phone:972-668-7460
Mailing Address - Fax:
Practice Address - Street 1:6200 W PARKER RD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-7939
Practice Address - Country:US
Practice Address - Phone:972-668-7460
Practice Address - Fax:972-668-7467
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0418207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX033733901Medicaid
TXMDJ0418OtherWORK COMP
TXMDJ0418OtherWORK COMP
TXF21153Medicare UPIN