Provider Demographics
NPI:1841234168
Name:GREWAL, HARINDER SINGH (MD)
Entity Type:Individual
Prefix:MR
First Name:HARINDER
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 1:330 LORETTO RD
Mailing Address - Street 2:STE 700
Mailing Address - City:LEBANON
Mailing Address - State:KY
Mailing Address - Zip Code:40033-1308
Mailing Address - Country:US
Mailing Address - Phone:270-692-6744
Mailing Address - Fax:270-692-6229
Practice Address - Street 1:330 LORETTO RD
Practice Address - Street 2:STE 700
Practice Address - City:LEBANON
Practice Address - State:KY
Practice Address - Zip Code:40033-1308
Practice Address - Country:US
Practice Address - Phone:270-692-6744
Practice Address - Fax:270-692-6229
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35697208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64018369Medicaid
KY64018369Medicaid
KY1855401Medicare ID - Type Unspecified