Provider Demographics
NPI:1750347639
Name:GREWAL, PUNEET KAUR (MD)
Entity type:Individual
Prefix:DR
First Name:PUNEET
Middle Name:KAUR
Last Name:GREWAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:530 W EATON AVE
Mailing Address - Street 2:STE K
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3400
Mailing Address - Country:US
Mailing Address - Phone:209-835-4232
Mailing Address - Fax:209-835-3246
Practice Address - Street 1:530 W EATON AVE
Practice Address - Street 2:STE K
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3400
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:2010-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA53793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A537930Medicaid
CA00A537930Medicaid
CAG17745Medicare UPIN