Provider Demographics
NPI:1063766657
Name:GURPREET S DHALIWAL MD P A
Entity type:Organization
Organization Name:GURPREET S DHALIWAL MD P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GURPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:DHALIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-551-6000
Mailing Address - Street 1:11803 SOUTH FWY
Mailing Address - Street 2:SUITE 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:
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:SUITE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-04
Last Update Date:2012-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty