Provider Demographics
NPI:1396713483
Name:GREWAL, SHIVRAJPAL (MD)
Entity type:Individual
Prefix:
First Name:SHIVRAJPAL
Middle Name:
Last Name:GREWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:402 W MORROW RD
Mailing Address - Street 2:100
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-6549
Mailing Address - Country:US
Mailing Address - Phone:918-245-2309
Mailing Address - Fax:918-293-3181
Practice Address - Street 1:402 W MORROW RD
Practice Address - Street 2:100
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6549
Practice Address - Country:US
Practice Address - Phone:918-245-2309
Practice Address - Fax:918-293-3181
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK13202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKC94990Medicare UPIN