Provider Demographics
NPI:1043259765
Name:TIBREWAL, ANIL KUMAR (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:KUMAR
Last Name:TIBREWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 E WHEATLAND RD
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4905
Mailing Address - Country:US
Mailing Address - Phone:972-298-4622
Mailing Address - Fax:972-298-4633
Practice Address - Street 1:1010 E WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4905
Practice Address - Country:US
Practice Address - Phone:972-298-4622
Practice Address - Fax:972-298-4633
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2844208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CB606OtherBLUE CROSS
TX203726901Medicaid
TX203726901Medicaid