Provider Demographics
NPI:1780601286
Name:DHALIWAL, GURPREET S (MD)
Entity type:Individual
Prefix:
First Name:GURPREET
Middle Name:S
Last Name:DHALIWAL
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 1:11803 SOUTH FWY
Mailing Address - Street 2:STE 210
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7012
Mailing Address - Country:US
Mailing Address - Phone:817-551-6000
Mailing Address - Fax:817-551-6008
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:STE 210
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7012
Practice Address - Country:US
Practice Address - Phone:817-551-6000
Practice Address - Fax:817-551-6008
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA450592084N0400X
TXN07282084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A450590Medicaid
TX46-1012160OtherTX ID
TX46-1012160OtherTX ID
CA00A450590Medicaid