Provider Demographics
NPI:1215297148
Name:DHALIWAL, SHAWNDEEP (MD)
Entity type:Individual
Prefix:
First Name:SHAWNDEEP
Middle Name:
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 1:3400 S DOUGLAS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150
Mailing Address - Country:US
Mailing Address - Phone:405-272-2850
Mailing Address - Fax:405-272-2898
Practice Address - Street 1:3400 S DOUGLAS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73150-1017
Practice Address - Country:US
Practice Address - Phone:405-272-2850
Practice Address - Fax:405-272-2898
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI390200000X
OK33247207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program