Provider Demographics
NPI:1982957338
Name:BRAR, TANJEET KAUR
Entity Type:Individual
Prefix:
First Name:TANJEET
Middle Name:KAUR
Last Name:BRAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 HOLIDAY WAY
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6611
Mailing Address - Country:US
Mailing Address - Phone:317-679-6007
Mailing Address - Fax:317-883-8010
Practice Address - Street 1:2885 HOLIDAY WAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6611
Practice Address - Country:US
Practice Address - Phone:317-679-6007
Practice Address - Fax:317-883-8010
Is Sole Proprietor?:No
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3620024591172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver