Provider Demographics
NPI:1346214178
Name:KANWAR, BALRAJ MOHAN SINGH (MD)
Entity type:Individual
Prefix:
First Name:BALRAJ
Middle Name:MOHAN SINGH
Last Name:KANWAR
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:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:802 HOPKINS ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-7379
Practice Address - Country:US
Practice Address - Phone:214-266-0700
Practice Address - Fax:214-266-0796
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171717505Medicaid
TX171717501Medicaid
TX171717503Medicaid
TX8W8723OtherBCBS
TX171717506Medicaid
TX171717504Medicaid
TX8W8723OtherBCBS
TX8D0138Medicare PIN